101 results on '"MENTAL health"'
Search Results
2. The interface of physical and mental health.
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Doherty, Anne and Gaughran, Fiona
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MENTAL health , *HEALTH , *CARDIOVASCULAR diseases risk factors , *DIABETES risk factors , *MENTAL health services , *CONSULTATION-liaison psychiatry , *MENTAL illness , *GOVERNMENT policy - Abstract
Purpose: The interaction between physical and mental health is complex. In this paper we aim to provide an overview of the main components of this relationship and to identify how care could be improved for people with co-morbidities. Methods: We performed a literature search of MedLine, Ovid and Psycinfo and identified studies that examined the association between mental illness and physical illness. We also examined the key policy documents and guidelines in this area. Results: People with mental health conditions are at higher risk of developing physical illness, have those conditions diagnosed later and have much higher mortality rates. Conversely, people with a diagnosis of physical illness, especially cardiovascular disease, diabetes and cancer have a greater chance of developing a mental health problem. When both mental and physical illnesses conditions are present together, there are higher overall rates of morbidity, healthcare utilisation, and poorer quality of life. Conclusions: Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems. [ABSTRACT FROM AUTHOR]
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- 2014
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3. Madness or Mental Illness? Revisiting Historians of Psychiatry.
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Gomory, Tomi, Cohen, David, and Kirk, Stuart
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MENTAL illness ,HISTORY of psychiatry ,MENTAL health services ,MEDICALIZATION ,MEDICINE ,PATHOLOGICAL psychology ,MENTAL health personnel - Abstract
Is madness medical disease, problems in living, or social labeling of deviance? Does the word merely refer to behavior peculiar enough to be disturbing? Are the mad mad because of mental, physical, or environmental vulnerabilities? No one knows the answers to these questions because there is no scientific validation for any theory or specific causes of madness. Nonetheless, a view of madness as medical/bodily disease has been receiving concrete and rhetorical support from the government mental health bureaucracy, Big Pharma, mental health lobby groups, the organized profession of psychiatry, hundreds of thousands of providers of mental health services and countless books and articles. This article explores the role that medicalized language and its use by seven noted historians of psychiatry (Norman Dain, Albert Deutsch, Gerald Grob, Roy Porter, Charles Rosenberg, Andrew Scull, and Edward Shorter) might have played in shaping the contemporary view of madness as mental illness. The evidence we uncover suggests that historical 'facts' about madness, much as psychiatric 'facts' supporting the disease model, are shaped by belief, bias, error or ambiguous rhetoric rather than the facts of the matter. [ABSTRACT FROM AUTHOR]
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- 2013
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4. Variations in Consumer Self-determination within US Psychiatric Advance Directives.
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Zeman, Laura Dreuth and Swanke, Jayme
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PSYCHIATRY , *MENTAL health , *AUTONOMY (Psychology) , *HEALTH care reform , *MEDICAL care , *CONSUMER behavior , *STATUTES , *MEDICINE , *MENTAL health services - Abstract
Advance directives are legal documents that formalize consumer psychiatric care preferences. This article examines the statutes and goals of US psychiatric advance directives within the framework of consumer self-determination, a priority in national mental health reform. It seeks to distinguish between state models based on the degree that consumer rights are integrated into advance directive statutes and goals. The data set contains information from legislative statutes and goals from the 24 US states that enacted explicit psychiatric advance directive regulations prior to 2006. Researchers grouped the data into categories based on the similarities in consumer self-determination. The findings include an examination of the spectrum of consumer self-determination in US advance directive statutes along with a comparison of the gaps between intent and policy in state statutes. [ABSTRACT FROM AUTHOR]
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- 2008
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5. Behavioral health problems as barriers to work: results from a 6-year panel study of welfare recipients.
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Zabkiewicz, Denise, Schmidt, Laura, and Schmidt, Laura A
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MENTAL illness , *MENTAL health services , *MEDICAL care , *PSYCHIATRY , *MEDICINE , *PSYCHIATRIC epidemiology , *PUBLIC welfare laws , *SUBSTANCE abuse & psychology , *EMPLOYMENT , *HEALTH status indicators , *LONGITUDINAL method , *PUBLIC welfare , *RESEARCH funding , *PSYCHOLOGY - Abstract
Over the course of welfare reform, behavioral health problems have emerged as significant issues. Welfare time limits have added urgency to recipients' efforts to obtain economic self-sufficiency and have raised new concerns about mental health and substance abuse problems as barriers to work. However, there is limited research on how behavioral health problems operate to impede the employability of welfare recipients. This analysis draws on data from a 6-year panel study of welfare recipients (n = 341) to examine how a broad spectrum of mental health and substance abuse problems impact efforts to obtain work while on aid and subsequent transitions from welfare to work. Recipients who reported symptoms of depression at baseline were less likely to actively search for work while on aid compared to others. However, they were no less likely to leave welfare for work within a 2-year time frame. In contrast, other problems - including hostility, interpersonal sensitivity, psychoticism, and heavy drug use - had significant effects on work exits from welfare but little association with job search activities. Overall, these results suggest that behavioral health problems do not operate in the same manner to inhibit transitions from welfare to work. Welfare-to-work programs should direct interventions towards the unique constellations of problems that recipients face. [ABSTRACT FROM AUTHOR]
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- 2007
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6. Development of mental health indicators at the district level in Madhya Pradesh, India: mixed methods study
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Petra C. Gronholm, Mark J. D. Jordans, Graham Thornicroft, Shalini Ahuja, and Rahul Shidhaye
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Research design ,Mental Health Services ,medicine.medical_specialty ,BF Psychology ,Service delivery framework ,India ,Context (language use) ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,RA0421 Public health. Hygiene. Preventive Medicine ,Medicine ,Health Status Indicators ,Humans ,030212 general & internal medicine ,Primary Health Care ,business.industry ,Health Policy ,Nursing research ,Public health ,Mental Disorders ,lcsh:Public aspects of medicine ,1. No poverty ,lcsh:RA1-1270 ,Mental health ,Community Mental Health Services ,030227 psychiatry ,3. Good health ,Mental Health ,business ,Delivery of Health Care ,Facilities and Services Utilization ,Mental Health Indicators ,Research Article ,Information Systems - Abstract
Background Strengthening routine information systems for mental health can augment scale up of community mental health services in India and other low- and middle-income countries. Currently little routine data is available in Indian settings. This study aimed to develop a core set of indicators for monitoring mental health care in primary health care settings Methods By using a sequential exploratory mixed methods design, key mental health indicators measuring service delivery and system performance were developed for the context of Madhya Pradesh, India. The research design involved a situation analysis, and conducting a prioritisation exercise and consultation workshops with key stakeholders. Results This study resulted in nine key mental health indicators covering both mental health service delivery indicators and mental health system indicators for Sehore district of Madhya Pradesh. Mean indicator priority scores ranging from 4.48 to 3.78 were reported. Conclusions This study demonstrated a phased approach to strengthen routine information systems for mental health at a primary care level in India. We recommend that similar research methods can be applied across comparable settings and these indicators can be adopted as a part of national routine information systems.
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- 2018
7. A 10-year history of perinatal care at the Brockington Mother and Baby Unit Stafford
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Kristina Hofberg, Athula Sumathipala, Caroline Carr, Debra J. Green, and Tina Fanneran
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Adult ,Mental Health Services ,Perinatal care ,Mothers ,Perinatal ,Unit (housing) ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Service Development ,Service (business) ,030219 obstetrics & reproductive medicine ,business.industry ,Mental Disorders ,Postpartum Period ,Infant, Newborn ,Infant ,Obstetrics and Gynecology ,Mental illness ,medicine.disease ,Mental health ,Mother-Child Relations ,Hospitalization ,Perinatal Care ,Psychiatry and Mental health ,Mental Health ,Mother and Baby ,Female ,business ,Hospital Units ,Postpartum period - Abstract
The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Perinatal mother and baby units are an essential service for women suffering from perinatal mental illness by allowing the baby to stay with the mother whilst receiving inpatient mental health care. Such units enable the mother to develop a relationship with her baby in a safe and supportive environment whilst caring for her mental health needs and allow her to gain confidence in her role as a mother. This article presents the development of the Brockington Mother and Baby unit and its progressive advancement towards an exemplary service for women suffering from perinatal mental illness. The Brockington Mother and Baby unit (MBU) at South Staffordshire and Shropshire Healthcare Foundation Trust (SSSFT) is celebrating its 10th anniversary and is one of six MBUs accredited as excellent by the Royal College of Psychiatry (RCPsych). The unit is a member of the Royal College of Psychiatrists’ Quality Care Network and thereby adheres to their national standard of care. This article describes the journey from a single lone worker in perinatal mental health to an exemplary service caring for women with perinatal mental illness during the first 12 months following the birth of their child.
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- 2015
8. Service provision and barriers to care for homeless people with mental health problems across 14 european capital cities
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Edina Gabor, Aleksandra Matanov, Jacek Moskalewicz, Pablo Nicaise, Aart H. Schene, Andrea Gaddini, Tim Greacen, Joaquim Soares, José Manuel Díaz-Olalla, Margaret M. Barry, Reamonn Canavan, Henrique Barros, Stefan Priebe, Ulrike Kluge, Christa Straßmayr, Petra Holcnerová, National University of Ireland, Galway, Ireland - Health Promotion Research Centre, Queen Mary University of London, London, UK - Unit for Social and Community Psychiatry, University of Porto Medical School, Porto, Portugal - Department of Hygiene and Epidemiology, National Institute for Health Development, Budapest, Hungary - National Institute for Health Development, Etablissement public de santé Maison Blanche, Paris, France - Laboratoire de recherche, Charles University, Prague, Czech Republic - Department of Psychiatry, 1st Faculty of Medicine, University Medicine Berlin, CCM, Berlin, Germany - Clinic for Psychiatry and Psychotherapy, Charite, UCL - SSS/IRSS - Institut de recherche santé et société, Institute of Psychiatry and Neurology, Warsaw, Poland - Institute of Psychiatry and Neurology, Madrid Salud, Madrid, Spain - Madrid Salud, Ludwig Boltzmann Institute for Social Psychiatry, Vienna, Austria - Ludwig Boltzmann Institute for Social Psychiatry, University of Amsterdam, Amsterdam, The Netherlands - Academic Medical Center, Karolinska Institute, Stockholm, Sweden - Department of Public Health Sciences, Public Health Agency, Lazio Region, Rome, Italy - Laziosanità ASP, ANS - Amsterdam Neuroscience, APH - Amsterdam Public Health, and Adult Psychiatry
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Mental Health Services ,medicine.medical_specialty ,Medicin och hälsovetenskap ,Service delivery framework ,Medical and Health Sciences ,Health Services Accessibility ,Health administration ,Nursing ,Medicine ,Humans ,Cities ,Qualitative Research ,Quality of Health Care ,Service (business) ,business.industry ,Nursing research ,Public health ,Health Policy ,lcsh:Public aspects of medicine ,Mental Disorders ,illness ,lcsh:RA1-1270 ,assertive community treatment ,Mental health ,Outreach ,Europe ,Long-term care ,MHSR ,Ill-Housed Persons ,business ,Research Article - Abstract
Background Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. Method Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. Results Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. Conclusions While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.
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- 2012
9. Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients
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Casey Bohrman, Stacey L. Barrenger, Amy Blank Wilson, and Jeffrey Draine
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Mental Health Services ,medicine.medical_specialty ,Health (social science) ,Health informatics ,Article ,Health Services Accessibility ,Treatment Refusal ,Humans ,Medicine ,Qualitative Research ,Philadelphia ,Service (business) ,Gatekeeping ,Health Services Needs and Demand ,Public Sector ,business.industry ,Health Policy ,Public health ,Public sector ,Public Health, Environmental and Occupational Health ,Focus Groups ,Public relations ,Focus group ,Mental health ,Health psychology ,business - Abstract
This research highlights the importance of expanding examinations of service accessibility for hard to engage client populations to include assessments of individuals’ ability to gain entrance to services and the system’s ability to meet the service needs of particular client populations. The results of this research provide a framework to support these examinations. The increasing levels of selectivity and targeting of mental health services to particular client populations found in this study raise fundamental questions about the goals of service accessibility in 21st century public mental health services generally, and for hard-to-engage clients particularly. These findings also point to the need for examinations of the eligibility criteria and gatekeeping mechanism that are used to target services to particular client populations to determine if they are working as intended and to assess what impact these mechanisms have on hard to engage clients’ ability to gain entrance to needed services.
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- 2012
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10. Expanding the Domains of Attitudes Towards Evidence-Based Practice: The Evidence Based Practice Attitude Scale-50
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Guy Cafri, Angelina C. Sawitzky, Gregory A. Aarons, and Lindsay Lugo
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Evidence-based practice ,Psychometrics ,Attitude of Health Personnel ,Dissemination ,Health informatics ,Health administration ,Clinician ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Humans ,0501 psychology and cognitive sciences ,030212 general & internal medicine ,Aged ,Original Paper ,business.industry ,Public health ,Health Policy ,05 social sciences ,Public Health, Environmental and Occupational Health ,Focus Groups ,Middle Aged ,Focus group ,Mental health ,Exploratory factor analysis ,Psychiatry and Mental health ,Attitudes ,Implementation ,Provider ,Phychiatric Mental Health ,Female ,Therapist ,Pshychiatric Mental Health ,business ,Factor Analysis, Statistical ,050104 developmental & child psychology ,Clinical psychology - Abstract
Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.
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11. A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial
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Johannes R. Anema, Sandra H van Oostrom, Berend Terluin, Willem van Mechelen, Henrica C.W. de Vet, Public and occupational health, General practice, Epidemiology and Data Science, EMGO - Musculoskeletal health, and EMGO - Mental health
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Adult ,Employment ,Male ,Mental Health Services ,education ,Occupational Health Services ,Psychological intervention ,Occupational safety and health ,Nursing ,Occupational Therapy ,Intervention (counseling) ,Humans ,Medicine ,ComputingMilieux_MISCELLANEOUS ,ComputingMilieux_THECOMPUTINGPROFESSION ,business.industry ,Mental Disorders ,Rehabilitation ,Job design ,Middle Aged ,Mental health ,Distress ,Health psychology ,Sick leave ,Feasibility Studies ,Female ,Sick Leave ,business - Abstract
INTRODUCTION: Little is known about feasibility and acceptability of return to work (RTW) interventions for mental health problems. RTW for mental health problems is more complicated than for musculoskeletal problems due to stigmatization at the workplace. A participatory workplace intervention was developed in which an employee and supervisor identify and prioritize obstacles and solutions for RTW guided by a RTW coordinator. This paper is a feasibility study of this innovative intervention for employees with distress. The aims of this study were to describe the reach and extent of implementation of the workplace intervention, the satisfaction and expectations of all stakeholders, and the intention to use the workplace intervention in the future. METHODS: Eligible for this study were employees who had been on sick leave from regular work for 2-8 weeks with distress. Data were collected from the employees, their supervisors, RTW coordinators, and occupational physicians by means of standardized matrices and questionnaires at baseline and 3 months follow-up. Reach, implementation, satisfaction, expectations, and maintenance regarding the workplace intervention were described. RESULTS: Of the 56 employees with distress eligible to receive the workplace intervention, 40 employees, their supervisors and RTW coordinators actually participated in the intervention. They identified 151 obstacles for RTW mostly related to job design, communication, mental workload and person-related stress factors. The 281 consensus-based solutions identified were mostly related to job design, communication and training. Of those solutions, 72% was realized at the evaluation with the employee and supervisor. Overall, employees, supervisors and occupational health professionals were satisfied with the workplace intervention and occupational health professionals rated it with a 7.1. Time-investment was the only barrier for implementation reported by the occupational health professionals. CONCLUSIONS: The results of this study indicate a high feasibility for a broad implementation of a participatory workplace intervention for employees with distress and lost time, and their supervisors
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12. Mental Health and Substance Abuse Characteristics Among a Clinical Sample of Urban American Indian/Alaska Native Youths in a Large California Metropolitan Area: a Descriptive Study
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Carrie L. Johnson and Daniel L. Dickerson
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Substance abuse ,Male ,Mental Health Services ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Urban Population ,Substance-Related Disorders ,Adjustment disorders ,Poison control ,Suicide prevention ,Trauma ,Occupational safety and health ,California ,Health(social science) ,Social support ,Young Adult ,Native Americans ,Behavior Therapy ,Environmental health ,Prevalence ,Medicine ,Humans ,Psychiatry ,Child ,business.industry ,Brief Report ,Mental Disorders ,American Indians ,Public Health, Environmental and Occupational Health ,Infant ,Social Support ,medicine.disease ,Mental health ,Psychiatry and Mental health ,Mental Health ,Child, Preschool ,Indians, North American ,Domestic violence ,Female ,business - Abstract
This study analyzes descriptive data among a clinical sample of American Indian/Alaska Native (AI/AN) youths receiving mental health services in a large California metropolitan area. Among 118 urban AI/AN youths, mood disorders (41.5%) and adjustment disorder (35.4%) were the most common mental health diagnoses. Alcohol (69.2%) and marijuana (50.0%) were the most commonly used substances. Witnessing domestic violence (84.2%) and living with someone who had a substance abuse problem (64.7%) were reported. The majority of patients demonstrated various behavior and emotional problems. Enhancing culturally relevant mental health and substance abuse treatment and prevention programs for urban AI/AN youth is suggested.
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13. Use of Pooled State Administrative Data for Mental Health Services Research
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Joseph P. Morrissey, Judy Zerzan, Kimberly Hoagwood, Jennifer P. Wisdom, Benjamin G. Druss, Molly Finnerty, Bradley D. Stein, Sheila A. Donahue, Meera Narasimhan, Susan M. Essock, Anne M. Libby, and Linda K. Frisman
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Mental Health Services ,medicine.medical_specialty ,Databases, Factual ,Public administration ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Research Support as Topic ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,National Institute of Mental Health (U.S.) ,Health policy ,States ,business.industry ,Public health ,Health Policy ,Systems ,Health services research ,Public Health, Environmental and Occupational Health ,Mental health ,United States ,030227 psychiatry ,Psychiatry and Mental health ,Policy ,Phychiatric Mental Health ,Original Article ,Health Services Research ,Pshychiatric Mental Health ,business ,Health care quality - Abstract
State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council’s “The Road Ahead: Research Partnership to Transform Services,” (http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals with mental disorders. The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states, and to address significant state-defined health policy initiatives. Five projects involving eight states were selected through peer review for funding. Projects began in 2009 and were funded for 3 years. This report provides a brief description of the five projects, followed by an analysis of the impact, challenges, and lessons learned from these policy-partnered studies. We conclude by offering suggestions on ways to use state administrative data for informing state health policies, which is especially timely given national and state changes in the structure and financing of healthcare.
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14. Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda
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Ingrid Mogren, Gunilla Krantz, Joseph Ntaganira, and Aline Umubyeyi
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Health (social science) ,Social Psychology ,Epidemiology ,Population ,Poison control ,Barriers to health care ,Suicidality ,Suicide prevention ,Health Services Accessibility ,Occupational safety and health ,Health(social science) ,Young Adult ,03 medical and health sciences ,Help-Seeking Behavior ,0302 clinical medicine ,Health care ,Self-efficacy for seeking mental health care ,Humans ,Medicine ,030212 general & internal medicine ,education ,Psychiatry ,Mental health literacy ,Self-efficacy ,Depressive Disorder ,Original Paper ,education.field_of_study ,Depression ,business.industry ,Rwanda ,Help seeking ,Patient Acceptance of Health Care ,Mental health ,Self Efficacy ,030227 psychiatry ,Suicide ,Psychiatry and Mental health ,Cross-Sectional Studies ,Female ,business - Abstract
Purpose Mental disorders commonly affect young people but usually go unrecognized and untreated. This study aimed to investigate help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care among young adults with current depression and/or suicidality in a low-income setting. Methods This cross-sectional study used two sub-populations: a sub-sample of those suffering from current depression and/or suicidality (n = 247) and another of those not suffering from these conditions and not suffering from any other mental condition investigated (n = 502). Help-seeking behaviours, barriers to care and self-efficacy for mental health care seeking were measured among those suffering from current depression and/or suicidality (n, %). Logistic regression was used to identify risk factors for experiencing barriers to care. Self-efficacy for seeking mental health care was compared between men and women in the two sub-populations. Results Of the 247 men and women with current depression and/or suicidality, 36.0 % sought help at a health care unit and 64.0 % from trusted people in the community. Only six people received help from a mental health professional. The identified barriers were mainly related to accessibility and acceptability of health services. For the population suffering from current depression and/or suicidality, the self-efficacy scale for seeking mental health care suggested a low confidence in accessing mental health care but a high confidence in respondents’ ability to successfully communicate with health care staff and to cope with consequences of seeking care. Conclusion The current study clearly highlights young adults’ poor access to mental health care services. To reach universal health coverage, substantial resources need to be allocated to mental health, coupled with initiatives to improve mental health literacy in the general population.
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15. Uses and Abuses of Patient Reported Outcome Measures (PROMs): Potential Iatrogenic Impact of PROMs Implementation and How It Can Be Mitigated
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Miranda Wolpert
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Mental Health Services ,medicine.medical_specialty ,Psychometrics ,Adolescent ,Child Health Services ,Test validity ,Health outcomes ,Health informatics ,Outcome measures ,Health administration ,Outcome Assessment, Health Care ,Medicine ,Humans ,Psychiatry ,Child ,Point of View ,Quality of Health Care ,business.industry ,Public health ,Health Policy ,Public Health, Environmental and Occupational Health ,Mental health ,Patient reported outcome measures ,United Kingdom ,Service evaluation ,Patient Outcome Assessment ,PROMS ,Psychiatry and Mental health ,Adolescent Health Services ,Clinical tools ,Phychiatric Mental Health ,Patient-reported outcome ,Self Report ,Pshychiatric Mental Health ,business - Abstract
Having been a national advocate for the use of patient reported outcome measures (PROMs) in Child and Adolescent Mental Health Services (CAMHS) in the UK for the last decade, I have become increasingly concerned that unless the potential iatrogenic impact of widespread policy requirement for use of PROMs (Department of Health, Children and Young People’s Health Outcomes Strategy, 2012) is recognised and addressed their real potential benefits (Sapyta et al., J Clin Psychol 61(2):145–153, 2005) may never be realized. Drawing on examples from PROMs implementation in CAMHS in the UK (Wolpert et al., J Ment Health 21(2):165–173, 2012a; Child Adolesc Mental Health 17(3):129–130, 2012b). I suggest key ways forward if PROMs are to support best clinical practice rather than undermine it.
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16. 'Did I bring it on myself?' An exploratory study of the beliefs that adolescents referred to mental health services have about the causes of their depression
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Sally Parkinson, Mary Target, Joshua Holmes, Virginia Eatough, Emily Stapley, and Nick Midgley
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Male ,Mental Health Services ,Moderate to severe ,Understanding ,050103 clinical psychology ,medicine.medical_specialty ,Adolescent ,Causal beliefs ,RJ101 ,media_common.quotation_subject ,Culture ,Exploratory research ,BF ,Victimisation ,law.invention ,psyc ,Blame ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interview, Psychological ,Developmental and Educational Psychology ,medicine ,Child and adolescent psychiatry ,Humans ,0501 psychology and cognitive sciences ,Pediatrics, Perinatology, and Child Health ,Child ,Psychiatry ,Referral and Consultation ,Depression (differential diagnoses) ,media_common ,Depression ,05 social sciences ,Original Contribution ,General Medicine ,Mental health ,Adolescence ,030227 psychiatry ,Psychiatry and Mental health ,Adolescent Behavior ,Pediatrics, Perinatology and Child Health ,Female ,Qualitative ,Psychology ,Stress, Psychological ,Clinical psychology - Abstract
Background: The causal beliefs which adults have regarding their mental health difficulties have been linked to help-seeking behaviour, treatment preferences and the outcome of therapy; yet the topic remains a relatively unexplored one in the adolescent literature. Aims: This exploratory study aims to explore the causal beliefs regarding depression among a sample of clinically referred adolescents. Design: 77 adolescents, aged between 11 and 17, all diagnosed with moderate to severe depression, were interviewed using a semi-structured interview schedule, at the beginning of their participation in a randomised controlled trial. Data were analysed qualitatively using Framework Analysis. Findings: The study identified three themes related to causal beliefs: 1) Bewilderment about why they were depressed; 2) Depression as a result of rejection, victimisation and stress; and 3) Something inside is to blame. Conclusion: Although some adolescents struggled to identify the causes of their depression, many identified stressful life experiences as the cause of their current depression. They also tended to emphasise their own negative ways of interpreting those events, and some believed that their depression was caused by something inside them. Adolescents’ causal beliefs are likely to have implications for the way they seek help and engage in treatment, making it important to understand how adolescents understand their difficulties.
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17. ‘One man’s medicine is another man’s poison’: a qualitative study of user perspectives on low intensity interventions for Obsessive-Compulsive Disorder (OCD)
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Karina Lovell, Peter Bower, Jasmin Knopp-Hoffer, Penny Bee, and Sarah Knowles
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Adult ,Male ,Mental Health Services ,050103 clinical psychology ,medicine.medical_specialty ,Obsessive-Compulsive Disorder ,Psychotherapist ,medicine.medical_treatment ,Psychological intervention ,Context (language use) ,03 medical and health sciences ,Social support ,Young Adult ,0302 clinical medicine ,Acceptability ,medicine ,Obsessive-compulsive disorder ,Humans ,0501 psychology and cognitive sciences ,Psychiatry ,Obsessive-compulsive disorder (OCD) ,Qualitative Research ,Aged ,Therapy uptake ,Cognitive Behavioral Therapy ,business.industry ,Nursing research ,Health Policy ,05 social sciences ,Flexibility (personality) ,Social Support ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Mental health ,030227 psychiatry ,Self Care ,Patient Satisfaction ,Research Design ,Cognitive therapy ,Female ,business ,Low intensity intervention ,Therapy engagement ,Delivery of Health Care ,Research Article - Abstract
Background: Low intensity interventions based on cognitive-behavioral therapy (CBT) such as computerized therapy or guided self-help can offer effective and accessible care for mild to moderate mental health problems. However, critics argue that by reducing therapist input and the level of experience of the professionals delivering therapy, low intensity interventions deprive users of critical 'active ingredients'. Thus, while demand management arguments support the use of low intensity interventions for OCD, their integration into existing mental health services remains incomplete. Studies of user views of low intensity interventions can offer valuable insights to define their role and optimize their implementation in practice. Methods: Qualitative interviews (n = 36) in adults with OCD explored user perspectives on the initiation, continuation and acceptability of two low intensity CBT interventions: guided self-help (6 h of professional support) and computerized CBT (1 h of professional support), delivered within the context of a large pragmatic effectiveness trial (ISRCTN73535163). Results: While uptake was relatively high, continued engagement with the low intensity interventions was complex, with the perceived limitations of self-help materials impacting on users' willingness to continue therapy. The addition of professional support provided an acceptable compromise between the relative benefits of self-help and the need for professional input. However, individual differences were evident in the extent to which this compromise was considered necessary and acceptable. The need for some professional contact to manage expectations and personalize therapy materials was amplified in users with OCD, given the unique features of the disorder. However, individual differences were again evident regarding the perceived value of face-to-face support. Conclusions: Overall the findings demonstrate the need for flexibility in the provision of low intensity interventions for OCD, responsive to user preferences, as these preferences impact directly on engagement with therapy and perceptions of effectiveness.
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18. Generalized anxiety disorder in primary care: mental health services use and treatment adequacy
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Pasquale Roberge, Arnaud Duhoux, Christian Bocti, Isabelle Raymond, Louise Fournier, François Normand-Lauzière, Marie Michèle Tanguay-Bernard, and Mireille Luc
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Generalized anxiety disorder ,Adolescent ,MEDLINE ,Quality indicators ,Treatment Adequacy ,Interviews as Topic ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Anti-Anxiety Agents ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Young adult ,Psychiatry ,Depression (differential diagnoses) ,Primary Care ,Quality of Health Care ,Primary Health Care ,business.industry ,Service Utilization ,Quebec ,Middle Aged ,medicine.disease ,Mental health ,Anxiety Disorders ,Pharmacotherapy ,3. Good health ,030227 psychiatry ,Psychotherapy ,Treatment Outcome ,Generalized Anxiety Disorder ,Anxiety ,Female ,Guideline Adherence ,medicine.symptom ,business ,Family Practice ,Research Article - Abstract
Purpose Generalized Anxiety Disorder (GAD) is a common mental disorder in the primary care setting, marked by persistent anxiety and worries. The aims of this study were to: 1) examine mental health services utilisation in a large sample of primary care patients; 2) explore detection of GAD and minimal standards for pharmacological and psychological treatment adequacy based on recommendation from clinical practice guidelines; 3) examine correlates of treatment adequacy, i.e. predisposing, enabling and needs factors according to the Behavioural Model of Health Care Use. Methods A sample of 373 adults meeting DSM-IV criteria for Generalized Anxiety Disorder in the past 12 months took part in this study. Data were drawn from the “Dialogue” project, a large primary care study conducted in 67 primary care clinics in Quebec, Canada. Following a mental health screening in medical clinics (n = 14833), patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). Multilevel logistic regression models were developed to examine correlates of treatment adequacy for pharmacological and psychological treatments. Results Results indicate that 52.5 % of participants were recognized as having GAD by a healthcare professional in the past 12 months, and 36.2 % of the sample received a pharmacological (24.4 %) and/or psychological treatment (19.2 %) meeting indicators based on clinical practice guidelines recommendations. The detection of GAD by a health professional and the presence of comorbid depression were associated with overall treatment adequacy. Conclusions This study suggests that further efforts towards GAD detection could lead to an increase in the delivery of evidence-based treatments. Key targets for improvement in treatment adequacy include regular follow up of patients with a GAD medication and access to psychotherapy from the primary care setting.
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19. A systematic review of mental health outcome measures for young people aged 12 to 25 years
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Debra Rickwood and Benjamin Kwan
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Youth ,Adolescent ,media_common.quotation_subject ,MEDLINE ,Change ,Routine outcome measure ,Feedback ,Young Adult ,Quality of life (healthcare) ,Intervention (counseling) ,Health care ,Outcome Assessment, Health Care ,medicine ,Humans ,Quality (business) ,Young adult ,Psychiatry ,Child ,media_common ,Quality of Health Care ,business.industry ,Mental Disorders ,Australia ,Cognition ,Mental health ,Psychiatry and Mental health ,Quality of Life ,Female ,Young people ,business ,Research Article - Abstract
Background Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12–25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range. Methods MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement. Results A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group. Conclusions With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems. Electronic supplementary material The online version of this article (doi:10.1186/s12888-015-0664-x) contains supplementary material, which is available to authorized users.
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20. Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)
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Kerry Petrovic, Barry G. Frost, Terry J. Lewin, Megan Turrell, Suzanne Johnston, Srinivasan Tirupati, Ketrina A. Sly, Sadanand Rajkumar, and Agatha M. Conrad
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Psychological intervention ,Health informatics ,Residential Facilities ,Health administration ,03 medical and health sciences ,Sub-acute ,0302 clinical medicine ,Nursing ,Recovery ,Acute care ,Medicine ,Humans ,030212 general & internal medicine ,Inpatients ,Descriptive statistics ,business.industry ,Health service evaluation ,Delivery of Health Care, Integrated ,Public health ,Nursing research ,Mental Disorders ,Health Policy ,Rehabilitation ,Mental health ,Serious mental illness ,Patient Discharge ,030227 psychiatry ,Hospitalization ,Caregivers ,Female ,business ,Subacute Care ,Research Article - Abstract
Background An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes. Methods A brief description of the unit’s establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations. Results The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = −1.15), followed by Social-connection (z-change = −0.82) and Self-belief (z-change = −0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern. Conclusions This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1939-8) contains supplementary material, which is available to authorized users.
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21. Setting priorities for mental health care in Nepal: a formative study
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Ivan H. Komproe, Mark J. D. Jordans, Mark Tomlinson, Nagendra P. Luitel, Centre for Public Mental Health, and Faculty of Health Sciences
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Mental Health Services ,Medical education ,Health Services Needs and Demand ,Poverty ,Primary Health Care ,business.industry ,Mental health care packages ,Theory of change ,Development ,Focus Groups ,Mental health ,Focus group ,Formative assessment ,Formative research ,Psychiatry and Mental health ,Health facility ,Nursing ,Nepal ,Health care ,Medicine ,Humans ,Human resources ,business ,Research Article - Abstract
BACKGROUND: There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this.METHODS: The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one.RESULTS: There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention.CONCLUSION: The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal.
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22. Characteristics and motivations of absconders from forensic mental health services: a case-control study
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Alexander I. F. Simpson, Treena Wilkie, Stephanie R. Penney, and Stephanie Fernane
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Adult ,Male ,Mental Health Services ,Risk ,Canada ,medicine.medical_specialty ,Patient Dropouts ,Substance-Related Disorders ,Poison control ,Forensic mental health ,Violence ,Risk Assessment ,Suicide prevention ,Occupational safety and health ,Forensic psychiatry ,Injury prevention ,Humans ,Medicine ,Family ,Psychiatry ,Absconding ,Motivation ,business.industry ,Mental Disorders ,Human factors and ergonomics ,Forensic Psychiatry ,Middle Aged ,medicine.disease ,Mental health ,Substance abuse ,Psychiatry and Mental health ,Case-Control Studies ,Female ,business ,Goals ,Research Article - Abstract
Background Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher. Methods We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients’ motives for absconding. Results Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration. Conclusions Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.
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23. Sociodemographic factors associated with the use of mental health services in depressed adults: results from the Korea National Health and Nutrition Examination Survey (KNHANES)
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Ju-Young Kim, Sungwon Roh, Sohye Kim, Hong Jin Jeon, and Se Jin Park
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Gerontology ,Adult ,Employment ,Male ,Mental Health Services ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Population ,Health administration ,Education ,Young Adult ,Age ,Asian People ,Health care ,Republic of Korea ,Odds Ratio ,Medicine ,Humans ,Use ,education ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Depression ,Public health ,Mental health service ,Health Policy ,Sociodemographic factor ,Odds ratio ,Middle Aged ,Nutrition Surveys ,Mental health ,Depressive mood ,Social Class ,Educational Status ,Female ,business ,Research Article - Abstract
Background The aims of this study were to determine the utilization of mental health services (MHSs) by adults with a depressive mood and to identify the influencing sociodemographic factors, using a nationwide representative Korean sample. Methods The study included 2735 subjects, aged 19 years or older, who had experienced a depressive mood continuously for over 2 weeks within the previous year, using the data from the KNHANES IV (Fourth Korea National Health and Nutrition Examination Survey), which was performed between 2007 and 2009, and involved a nationally representative sample of the Korean community population who were visited at home. A multivariate logistic regression analysis was used to estimate the adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for the use of MHSs, which was defined as using healthcare institutions, consulting services, and inpatient or outpatient treatments due to mental health problems. Results MHSs had been used by 9.6% of the subjects with a depressive mood. The use of the MHSs was significantly associated with age, education level, and employment status, after adjusting for sociodemographic and health-related factors. Specifically, the OR for the nonuse of MHSs by the elderly (≥65 years) relative to subjects aged 19–34 years was 2.55 (95% CI = 1.13–5.76), subjects with a lower education level were less likely to use MHSs compared to those with a higher education level (7–9 years, OR = 2.35, 95% CI = 1.19–4.64; 10–12 years, OR = 1.66, 95% CI = 1.07–2.56; ≥13 years, reference), and the OR of unemployed relative to employed was 0.47 (95% CI = 0.32–0.67). Conclusions Among Korean adults with a depressive mood, the elderly, those with a lower education level, and the employed are less likely to use MHSs. These findings suggest that mental health policies should be made based on the characteristics of the population in order to reduce untreated patients with depression. Greater resources and attention to identifying and treating depression in older, less educated, and employed adults are warranted.
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24. ‘Mind the gap’ - mapping services for young people with ADHD transitioning from child to adult mental health services
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Charlotte L. Hall, Karen Newell, Kapil Sayal, Chris Hollis, Katie D Swift, and John Taylor
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Transition to Adult Care ,Adolescent ,media_common.quotation_subject ,MEDLINE ,Primary care ,Specific knowledge ,behavioral disciplines and activities ,Service mapping ,mental disorders ,medicine ,Humans ,ADHD ,Adults ,Psychiatry ,media_common ,Health Services Needs and Demand ,Health professionals ,Primary Health Care ,Continuity of Patient Care ,Mental health ,Adult life ,Psychiatry and Mental health ,Feeling ,England ,Adolescent Health Services ,Attention Deficit Disorder with Hyperactivity ,Transition ,Attention deficit ,Female ,Psychology ,Research Article - Abstract
Background: Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. Method: We report the findings of a survey of 96 healthcare professionals working in children’s (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Results: Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. Conclusions: We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.
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25. Mental illness research in the Gulf Cooperation Council: a scoping review
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Jason Hickey, Steven Pryjmachuk, and Heather Waterman
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Male ,Mental Health Services ,Scoping review ,medicine.medical_specialty ,Culture ,Psychological intervention ,Review ,Health administration ,Middle East ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Middle Eastern Mental Health Issues & Syndromes ,Humans ,Medicine ,030212 general & internal medicine ,Cooperative Behavior ,Qatar ,Developing Countries ,Health policy ,business.industry ,Mental Disorders ,Public health ,Health Policy ,Health services research ,Mental illness ,medicine.disease ,Mental health ,Arabs ,030227 psychiatry ,Mental Health ,Female ,Health Services Research ,business ,Delivery of Health Care - Abstract
Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users’ experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services.This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users’ experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting.From this review, it is clear that the sociocultural context in the region is linked to service users’ experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region.
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26. The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)
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Mike, Slade, Harriet, Jordan, Eleanor, Clarke, Paul, Williams, Helena, Kaliniecka, Katrin, Arnold, Andrea, Fiorillo, Domenico, Giacco, Mario, Luciano, Anikó, Égerházi, Marietta, Nagy, Malene Krogsgaard, Bording, Helle Østermark, Sørensen, Wulf, Rössler, Wolfram, Kawohl, Bernd, Puschner, Caitriona, Obermann, University of Zurich, and Slade, Mike
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Male ,Translation ,Psychometrics ,ASSESSMENT GRID TAG ,Applied psychology ,Satisfaction ,RECOVERY INSTRUMENT ,THERAPEUTIC ALLIANCE ,Recovery ,Surveys and Questionnaires ,Medicine ,Language ,PATIENT SATISFACTION ,Mental Disorders ,Health Policy ,SEVERE MENTAL-ILLNESS ,Cultural Diversity ,Focus Groups ,Middle Aged ,3. Good health ,Convergent validity ,Patient Satisfaction ,Scale (social sciences) ,Female ,Mental health ,Clinical decision-making ,Psychometric ,Research Article ,Predictive validity ,Adult ,Mental Health Services ,PSYCHIATRISTS EXPERIENCES ,Adolescent ,Decision Making ,610 Medicine & health ,Patient reported outcome measure ,VALIDATION ,Quality of life (healthcare) ,Patient satisfaction ,Nursing ,Humans ,Translations ,OPTION SCALE ,EPIDEMIOLOGICALLY REPRESENTATIVE SAMPLE ,business.industry ,Discriminant validity ,Focus group ,2719 Health Policy ,10054 Clinic for Psychiatry, Psychotherapy, and Psychosomatics ,HEALTH-CARE ,Involvement ,business - Abstract
The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) – with versions for patients (CDIS-P) and staff (CDIS-S) – for use in mental health services. An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments . ISRCTN75841675 .
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27. Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol
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Luis García-Ortiz, José I. Recio-Rodríguez, Diana Pérez-Arechaederra, Maria C. Patino-Alonso, Sara Mora-Simon, Concepción Becerro-Muñoz, Manuel A. Gómez-Marcos, Emiliano Rodriguez-Sanchez, and Nieves Porras-Santos
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Male ,Mental Health Services ,Psychological intervention ,law.invention ,Social support ,Study Protocol ,Quality of life (healthcare) ,Randomized controlled trial ,Nursing ,law ,Intervention (counseling) ,Surveys and Questionnaires ,Health care ,Medicine ,Humans ,Cognitive Behavioral Therapy ,Primary Health Care ,business.industry ,Family caregivers ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Mental health ,Caregivers ,Spain ,Quality of Life ,Female ,business ,Program Evaluation - Abstract
Background Although Primary Health Care (PHC) Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. Methods/Design This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. Measurements: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1) Assessment of different socio-demographic related to care, and caregiver's personal situation. 2)Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ). 3)Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire), burden short questionnaire (Short Zarit Burden Interview), quality of life (Ruiz & Baca: 1993 Questionnaire), the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4) Intervention implementation measures will also be assessed. Intervention: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia. Discussion Psychotherapeutic interventions have been proved to obtain better results to reduce symptomatology and improve emotional state of caregivers. Moreover, this intervention has been proved to be effective in a different setting other than PHC, and was developed by professionals of Mental Health. If we found that this intervention is effective in PHC and with our professionals, it would be an important instrument to offer to caregivers of care-dependent patients. Trial Registration ClinicalTrials.gov Identifier NCT01177696
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28. Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study
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Victoria Bird, Sheri Oduola, Mike Slade, Helen Gilburt, and Tom K. J. Craig
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Mental Health Services ,Organizational change ,Program evaluation ,Health Personnel ,Organizational commitment ,Care provision ,Superordinate goals ,Nursing ,Recovery ,Intervention (counseling) ,PROGRAM ,Humans ,Medicine ,Qualitative Research ,Primary Health Care ,BARRIERS ,business.industry ,Mental Disorders ,Mental health ,Organizational Innovation ,Health services ,Psychiatry and Mental health ,Implementation ,Thematic analysis ,business ,Program Evaluation ,Research Article ,Qualitative research - Abstract
Background: Recovery has become an increasingly prominent concept in mental health policy internationally. However, there is a lack of guidance regarding organisational transformation towards a recovery orientation. This study evaluated the implementation of recovery-orientated practice through training across a system of mental health services. Methods: The intervention comprised four full-day workshops and an in-team half-day session on supporting recovery. It was offered to 383 staff in 22 multidisciplinary community and rehabilitation teams providing mental health services across two contiguous regions. A quasi-experimental design was used for evaluation, comparing behavioural intent with staff from a third contiguous region. Behavioural intent was rated by coding points of action on the care plans of a random sample of 700 patients (400 intervention, 300 control), before and three months after the intervention. Action points were coded for (a) focus of action, using predetermined categories of care; and (b) responsibility for action. Qualitative inquiry was used to explore staff understanding of recovery, implementation in services and the wider system, and the perceived impact of the intervention. Semi-structured interviews were conducted with 16 intervention group team leaders post-training and an inductive thematic analysis undertaken. Results: A total of 342 (89%) staff received the intervention. Care plans of patients in the intervention group had significantly more changes with evidence of change in the content of patient's care plans (OR 10.94. 95% CI 7.01-17.07) and the attributed responsibility for the actions detailed (OR 2.95, 95% CI 1.68-5.18). Nine themes emerged from the qualitative analysis split into two superordinate categories. 'Recovery, individual and practice', describes the perception and provision of recovery orientated care by individuals and at a team level. It includes themes on care provision, the role of hope, language of recovery, ownership and multidisciplinarity. 'Systemic implementation', describes organizational implementation and includes themes on hierarchy and role definition, training approaches, measures of recovery and resources. Conclusions: Training can provide an important mechanism for instigating change in promoting recovery-orientated practice. However, the challenge of systemically implementing recovery approaches requires further consideration of the conceptual elements of recovery, its measurement, and maximising and demonstrating organizational commitment.
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29. Evaluating the effectiveness of a training program that builds teachers’ capability to identify and appropriately refer middle and high school students with mental health problems in Brazil: an exploratory study
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Ary Gadelha, Isabel Altenfelder Santos Bordin, Tais Silveira Moriyama, Marlene A. Vieira, Rodrigo A. Bressan, Universidade Federal de São Paulo (UNIFESP), and Natl Inst Dev Psychiat Children & Adolescents INP
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Program evaluation ,Adult ,Male ,Mental Health Services ,Longitudinal study ,medicine.medical_specialty ,Primary and secondary ,Referral ,Adolescent ,Teaching method ,education ,Exploratory research ,Education ,Professional training ,Medicine ,Humans ,Longitudinal Studies ,Psychiatry ,Students ,Referral and Consultation ,School Health Services ,Medical education ,Schools ,business.industry ,Mental Disorders ,Teaching ,Professional development ,Public Health, Environmental and Occupational Health ,Middle Aged ,School health ,medicine.disease ,Mental health ,Adolescence ,Conduct disorder ,Adolescent Health Services ,Case-Control Studies ,Child, Preschool ,Female ,business ,Brazil ,Research Article ,Program Evaluation - Abstract
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: in Brazil, like many countries, there has been a failure to identify mental health problems (MHP) in young people and refer them to appropriate care and support. the school environment provides an ideal setting to do this. Therefore, effective programs need to be developed to train teachers to identify and appropriately refer children with possible MHP. We aimed to evaluate teachers' ability to identify and appropriately refer students with possible MHP, and the effectiveness of a psychoeducational strategy to build teachers' capability in this area.Methods: To meet the first objective, we conducted a case-control study using a student sample. To meet the second, we employed longitudinal design with repeated measures before and after introducing the psychoeducational strategy using a teacher sample. in the case control study, the Youth Self-Report was used to investigate internalizing and externalizing problems. Before training, teachers selected 26 students who they thought were likely to have MHP. Twenty-six non-selected students acted as controls and were matched by gender, age and grade. the underlying principle was that if teachers could identify abnormal behaviors among their actual students, those with some MHP would likely be among the case group and those without among the control group. in the longitudinal study, 32 teachers were asked to evaluate six vignettes that highlighted behaviors indicating a high risk for psychosis, depression, conduct disorder, hyperactivity, mania, and normal adolescent behavior. We calculated the rates of correct answers for identifying the existence of some MHP and the need for referral before and after training; teachers were not asked to identify the individual conditions.Results: Teachers were already able to identify the most symptomatic students, who had both internalizing and externalizing problems, as possibly having MHP, but teachers had difficulty in identifying students with internalizing problems alone. At least 50.0% of teachers learned to identify hypothetical cases as problematic and to make the appropriate referral, and 60.0% of teachers who before training could not identify normal adolescence learned to do so.Conclusions: the strategy was partially effective but could be improved mainly by extending its duration, and including discussion of actual cases. Universidade Federal de São Paulo UNIFESP, Dept Psychiat, BR-04038030 São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, Dept Psychiat, LINC, BR-04038030 São Paulo, Brazil Natl Inst Dev Psychiat Children & Adolescents INP, São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, Dept Psychiat, BR-04038030 São Paulo, Brazil Universidade Federal de São Paulo UNIFESP, Dept Psychiat, LINC, BR-04038030 São Paulo, Brazil Web of Science
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30. Using vignettes to assess contributions to the work of addressing child mental health problems in primary care
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Kate E. Fothergill, Eric P. Slade, Anne E. Ruble, Waleed Zafar, and Lawrence S. Wissow
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Mental Health Services ,medicine.medical_specialty ,Adolescent ,Collaborative Care ,Workload ,Pediatrics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Surveys and Questionnaires ,Health care ,Medicine ,Humans ,Vignettes ,Transitional care ,Practice Patterns, Physicians' ,Child ,Survey ,Unlicensed assistive personnel ,Children ,Health policy ,Depressive Disorder ,Maryland ,Primary Health Care ,business.industry ,Public health ,Health Policy ,Transitional Care ,Task shifting ,Primary care ,Mental health ,Anxiety Disorders ,030227 psychiatry ,3. Good health ,Collaborative care ,Attention Deficit Disorder with Hyperactivity ,Family medicine ,Female ,business ,Research Article - Abstract
Background To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 % female, 58 % at their site 10 or more years; 44 % in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. Results The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50 %) increase in work (95 % CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P
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31. Socio-economic factors linked with mental health during the recession: a multilevel analysis
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Isabel Ruiz-Pérez, Clara Bermúdez-Tamayo, Miguel Rodríguez-Barranco, Escuela Andaluza de Salud Pública, Granada, Spain. CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. Biosanitary Institute of Granada (Ibs.GRANADA), Granada, Spain., and This study was partially funded by the Regional Government of Andalusia Ministry of Health PI 0360-2012 and CIBER Epidemiología y Salud Pública.
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Male ,Financing, Government ,Psychiatry and Psychology::Mental Disorders [Medical Subject Headings] ,Health Status ,Recession ,0302 clinical medicine ,Health care ,Per capita ,Anthropology, Education, Sociology and Social Phenomena::Social Sciences::Economics::Economic Recession [Medical Subject Headings] ,030212 general & internal medicine ,Socioeconomics ,media_common ,Salud Mental ,Health Care::Population Characteristics::Health::Mental Health [Medical Subject Headings] ,Desempleo ,Mental Disorders ,Health Policy ,Health services research ,Health Care::Population Characteristics::Socioeconomic Factors::Employment::Unemployment [Medical Subject Headings] ,Factores Socioeconómicos ,Per capita income ,Middle Aged ,Economic Recession ,Mental Health ,Recesión Económica ,Multilevel Analysis ,Female ,0305 other medical science ,Psychology ,Adult ,Employment ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Financial crisis ,03 medical and health sciences ,Desigualdades en la Salud ,Young Adult ,Sex Factors ,medicine ,Anthropology, Education, Sociology and Social Phenomena::Social Sciences::Sociology::Socioeconomic Factors [Medical Subject Headings] ,Humans ,Health policy ,030505 public health ,business.industry ,Public health ,Research ,Public Health, Environmental and Occupational Health ,Health Inequalities ,Mental health ,Health Surveys ,Cross-Sectional Studies ,Logistic Models ,Socioeconomic Factors ,Spain ,Health Expenditures ,Socio-economic indicators ,business - Abstract
Background Periods of financial crisis are associated with higher psychological stress among the population and greater use of mental health services. The objective is to analyse contextual factors associated with mental health among the Spanish population during the recession. Methodology Cross-sectional, descriptive study of two periods: before the recession (2006) and after therecession (2011-2012). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. There were 25,234 subjects (2006) and 20,754 subjects (2012). The dependent variable was psychic morbidity. Independent variables: 1) socio-demographic (age, socio-professional class, level of education, nationality, employment situation, marital status), 2) psycho-social (social support) and 3) financial (GDP per capita, risk of poverty, income per capita per household), public welfare services (health spending per capita), labour market (employment and unemployment rates, percentage of temporary workers). Multilevel logistic regression models with mixed effects were constructed to determine change in psychic morbidity according to the variables studied. Results The macroeconomic variables associated with worse mental health for both males and females were lower health spending per capita and percentage of temporary workers. Among women, the risk of poor mental health increased 6% for each 100€ decrease in healthcare spending per capita. Among men, the risk of poor mental health decreased 8% for each 5-percentage point increase in temporary workers. Conclusions Higher rates of precarious employment in a region have a negative effect on people’s mental health; likewise lower health spending per capita. Policies during periods of recession should focus on support and improved conditions for vulnerable groups such as temporary workers. Healthcare cutbacks should be avoided in order to prevent increased prevalence of poor mental health. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0518-x) contains supplementary material, which is available to authorized users.
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32. Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway
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Kathleen Pajer, Sarah Reid, Christine Polihronis, Mona Jabbour, Nick Barrowman, Allison Kennedy, Roger Zemek, Paula Cloutier, Mario Cappelli, Clare Gray, and William Gardner
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Mental Health Services ,medicine.medical_specialty ,Adolescent ,Service integration ,Clinical Decision-Making ,Health Informatics ,Health informatics ,Health administration ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Clinical pathway ,Nursing ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Care transitions ,Child ,Health policy ,Risk assessment ,Pediatric ,Medicine(all) ,business.industry ,Emergency department ,030503 health policy & services ,Public health ,Mental Disorders ,Health Policy ,Health services research ,Public Health, Environmental and Occupational Health ,General Medicine ,medicine.disease ,Mental health ,3. Good health ,Scoring tools ,Implementation ,Critical Pathways ,Medical emergency ,Health Services Research ,0305 other medical science ,business ,Emergency Service, Hospital ,Program Evaluation - Abstract
While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP. This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites. This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP is best implemented among partner organizations to deliver evidence-based risk management of children and youth presenting with MH concerns. More broadly, it will contribute to the body of evidence supporting clinical pathway implementation within novel partnerships. ClinicalTrials.gov ( NCT02590302 )
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33. Smoking and mental illness: results from population surveys in Australia and the United States
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Stephen R. Zubrick, Francis Mitrou, and David Lawrence
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Population ,Young Adult ,Prevalence of mental disorders ,medicine ,Humans ,National Health Interview Survey ,Psychiatry ,education ,education.field_of_study ,business.industry ,Mental Disorders ,lcsh:Public aspects of medicine ,Public health ,Smoking ,Australia ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,medicine.disease ,Mental illness ,Mental health ,Comorbidity ,United States ,Schizophrenia ,Female ,business ,Stress, Psychological ,Research Article - Abstract
Background Smoking has been associated with a range of mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer. As many people who meet diagnostic criteria for mental disorders do not seek treatment for these conditions, we sought to investigate the relationship between mental illness and smoking in recent population-wide surveys. Methods Survey data from the US National Comorbidity Survey-Replication conducted in 2001–2003, the 2007 Australian Survey of Mental Health and Wellbeing, and the 2007 US National Health Interview Survey were used to investigate the relationship between current smoking, ICD-10 mental disorders and non-specific psychological distress. Population weighted estimates of smoking rates by disorder, and mental disorder rates by smoking status were calculated. Results In both the US and Australia, adults who met ICD-10 criteria for mental disorders in the 12 months prior to the survey smoked at almost twice the rate of adults without mental disorders. While approximately 20% of the adult population had 12-month mental disorders, among adult smokers approximately one-third had a 12-month mental disorder – 31.7% in the US (95% CI: 29.5%–33.8%) and 32.4% in Australia (95% CI: 29.5%–35.3%). Female smokers had higher rates of mental disorders than male smokers, and younger smokers had considerably higher rates than older smokers. The majority of mentally ill smokers were not in contact with mental health services, but their rate of smoking was not different from that of mentally ill smokers who had accessed services for their mental health problem. Smokers with high levels of psychological distress smoked a higher average number of cigarettes per day. Conclusion Mental illness is associated with both higher rates of smoking and higher levels of smoking among smokers. Further, a significant proportion of smokers have mental illness. Strategies that address smoking in mental illness, and mental illness among smokers would seem to be important directions for tobacco control. As the majority of smokers with mental illness are not in contact with mental health services for their condition, strategies to address mental illness should be included as part of population health-based mental health and tobacco control efforts.
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34. South Asian populations in Canada: migration and mental health
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Nazilla Khanlou, Farah Islam, and Hala Tamim
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Adult ,Employment ,Male ,Mental Health Services ,Gerontology ,Canada ,Minority group ,Health Status ,Prevalence ,Emigrants and Immigrants ,Social determinants of mental health ,Asian People ,Humans ,South Asian ,Medicine ,Asia, Southeastern ,Migration ,First generation immigrant ,business.industry ,Mental Disorders ,Canadian-born ,Emigration and Immigration ,Middle Aged ,medicine.disease ,Mental illness ,Mental health ,Physical activity level ,Psychiatry and Mental health ,Mental Health ,Mood disorders ,Community health ,Anxiety ,Female ,Self Report ,medicine.symptom ,Second generation immigrant ,business ,Research Article ,Immigrant ,Demography - Abstract
Background South Asian populations are the largest visible minority group in Canada; however, there is very little information on the mental health of these populations. The objective of this study was to determine the prevalence rates and characteristics of mental health outcomes for South Asian first-generation immigrant and second-generation Canadian-born populations. Methods The Canadian Community Health Survey (CCHS) 2011 was used to calculate the estimated prevalence rates of the following mental health outcomes: mood disorders, anxiety disorders, fair-poor self-perceived mental health status, and extremely stressful life stress. The characteristics associated with these four mental health outcomes were determined through multivariate logistic regression analysis of merged CCHS 2007–2011 data. Results South Asian Canadian-born (3.5%, 95% CI 3.4-3.6%) and South Asian immigrant populations (3.5%, 95% CI 3.5-3.5%) did not vary significantly in estimated prevalence rates of mood disorders. However, South Asian immigrants experienced higher estimated prevalence rates of diagnosed anxiety disorders (3.4%, 95% CI 3.4-3.5 vs. 1.1%, 95% CI 1.1-1.1%) and self-reported extremely stressful life stress (2.6%, 95% CI 2.6-2.7% vs. 2.4%, 95% CI 2.3-2.4%) compared to their Canadian-born counterparts. Lastly, South Asian Canadian-born populations had a higher estimated prevalence rate of poor-fair self-perceived mental health status (4.4%, 95% CI 4.3-4.5%) compared to their immigrant counterparts (3.4%, 95% CI 3.3-3.4%). Different profiles of mental health determinants emerged for South Asian Canadian-born and immigrant populations. Female gender, having no children under the age of 12 in the household, food insecurity, poor-fair self-rated health status, being a current smoker, immigrating to Canada before adulthood, and taking the CCHS survey in either English or French was associated with greater risk of negative mental health outcomes for South Asian immigrant populations, while not being currently employed, having a regular medical doctor, and inactive physical activity level were associated with greater risk for South Asian Canadian-born populations. Conclusions Mental health outreach programs need to be cognizant of the differences in prevalence rates and characteristics of mental health outcomes for South Asian immigrant and Canadian-born populations to better tailor mental health services to be responsive to the unique mental health needs of South Asian populations in Canada.
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35. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial
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Frans R.J. Verhey, Maud Graff, Myrra Vernooij-Dassen, Hub Wollersheim, Richard Grol, Anouk Spijker, and Eddy M. M. Adang
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Mental Health Services ,Institutionalisation ,Aetiology, screening and detection [ONCOL 5] ,lcsh:Geriatrics ,law.invention ,Quality of Care [ONCOL 4] ,Study Protocol ,Professional Competence ,Ambulatory care ,Nursing ,Randomized controlled trial ,law ,Health care ,Ambulatory Care ,Medicine ,Dementia ,Cluster Analysis ,Humans ,Single-Blind Method ,Alzheimer Centre [NCEBP 11] ,Competence (human resources) ,Hereditary cancer and cancer-related syndromes [ONCOL 1] ,business.industry ,Effective primary care and public health [NCEBP 7] ,medicine.disease ,Mental health ,lcsh:RC952-954.6 ,Caregivers ,Evaluation of complex medical interventions [NCEBP 2] ,Secondary Outcome Measure ,Geriatrics and Gerontology ,business ,Quality of hospital and integrated care [NCEBP 4] - Abstract
Contains fulltext : 81435.pdf (Publisher’s version ) (Open Access) BACKGROUND: Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD). The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study. METHODS AND DESIGN: In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses) have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads) coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives. DISCUSSION: A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in costs in the management of dementia. Implementation on a national level will be started if the SCPD proves to be efficient. TRIAL REGISTRATION: NCT00147693.
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36. A qualitative study on the ethics of transforming care: examining the development and implementation of Canada’s first mental health strategy
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Raphael Lencucha, Hiba Zafran, Cheryl Mattingly, Laurence J. Kirmayer, and Melissa Park
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Mental Health Services ,030506 rehabilitation ,medicine.medical_specialty ,Canada ,Participatory research ,Everyday ethics ,Community organization ,Ethnography ,Health Informatics ,Health informatics ,Regional Health Planning ,Practice guidelines ,Health administration ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Nursing ,Recovery ,Medicine ,Humans ,030212 general & internal medicine ,Program Development ,Policy Making ,Health policy ,Qualitative Research ,Medicine(all) ,business.industry ,Public health ,Health Policy ,Health services research ,Public Health, Environmental and Occupational Health ,General Medicine ,Public relations ,Mental health ,Organizational Innovation ,3. Good health ,Mental Health ,Policy ,0305 other medical science ,business ,Hospital accreditation - Abstract
Background The Mental Health Commission of Canada worked collaboratively with stakeholders to create a new framework for a federal mental health strategy, which is now mandated for implementation by 2017. The proposed strategies have been written into provincial health plans, hospital accreditation standards, and the annual objectives of psychiatric departments and community organizations. This project will explore the decision-making process among those who contributed to Canada’s first federal mental health policy and those implementing this policy in the clinical setting. Despite the centrality of ethical reasoning to the successful uptake of the recent national guidelines for recovery-oriented care, to date, there are no studies focused exclusively on the ethical tensions that emerged and continue to emerge during the creation and implementation of the new standards for recovery-oriented practice. Methods/design This two-year Canadian Institute of Health Research Catalyst Grant in Ethics (2015–2017) consists of three components. C-I, a retrospective, qualitative study consisting of document analysis and interviews with key policy-makers of the ethical tensions that arose during the development of Canada’s Mental Health Strategy will be conducted in parallel to C-II, a theory-based, focused ethnography of how mental health practitioners in a psychiatric setting reason about and act upon new standards in everyday practice. Case-based scenarios of ethical tensions will be developed from C-I/II and fed-forward to C-III: participatory forums with policy-makers, mental health practitioners, and other stakeholders in recovery-oriented services to collectively identify and prioritize key ethical concerns and generate action steps to close the gap between the policy-making process and its implementation at the local level. Discussion Policy-makers and clinicians make important everyday decisions that effect the creation and implementation of new practice standards. Particularly, there is a need to understand how ethical dilemmas that arise during this decision-making process and the reasoning and resources they use to resolve these tensions impact on the implementation process. This catalyst grant in ethics will (1) introduce a novel line of inquiry focusing on the ethical tensions that arose in the development of Canada’s first mental health strategy, while (2) intensifying our focus on the ethical aspects of moving policy into action.
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37. Effect of a structured psycho-oncological screening and treatment model on mental health in cancer patients (STEPPED CARE): study protocol for a cluster randomized controlled trial
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Kirsten Papsdorf, Franziska Schiefke, Hubert Wirtz, Anette Kersting, Jens Einenkel, Jens-Uwe Stolzenburg, Arne Dietrich, Jürgen Meixensberger, Florian Lordick, Joachim Mössner, Susanne Briest, Helge Danker, Dietger Niederwieser, Torsten Prietzel, Susanne Singer, and Andreas Dietz
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Mental Health Services ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Time Factors ,Attitude of Health Personnel ,Cluster randomized trial ,Medicine (miscellaneous) ,Psycho-oncology ,law.invention ,Study Protocol ,Quality of life (healthcare) ,Clinical Protocols ,Randomized controlled trial ,Predictive Value of Tests ,law ,Germany ,Neoplasms ,Physicians ,Surveys and Questionnaires ,Health care ,Humans ,Medicine ,Pharmacology (medical) ,Cluster randomised controlled trial ,Patient participation ,Referral and Consultation ,Psychiatric Status Rating Scales ,Academic Medical Centers ,Physician-Patient Relations ,business.industry ,Communication ,Healthcare ,Prognosis ,Mental health ,Distress ,Mental Health ,Oncology ,Research Design ,Family medicine ,Quality of Life ,Screening ,Patient Participation ,business ,Psychosocial ,Stress, Psychological ,RCT - Abstract
High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients. This study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards. Mental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective. Clinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.
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38. A prospective study of mental health care for comorbid depressed mood in older adults with painful osteoarthritis
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Yehoshua Gleicher, Ruth Croxford, Jacqueline Hochman, and Gillian A. Hawker
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Mental Health Services ,medicine.medical_specialty ,lcsh:RC435-571 ,Health Status ,Pain ,Logistic regression ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,lcsh:Psychiatry ,Severity of illness ,Osteoarthritis ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Prospective Studies ,Medical prescription ,Psychiatry ,Prospective cohort study ,Depression (differential diagnoses) ,Aged ,030203 arthritis & rheumatology ,Psychiatric Status Rating Scales ,Sex Characteristics ,business.industry ,Depression ,medicine.disease ,Mental health ,Comorbidity ,Health Surveys ,Antidepressive Agents ,3. Good health ,Psychiatry and Mental health ,Prescriptions ,Cohort ,Female ,business ,Research Article - Abstract
Background Comorbid depression is common among adults with painful osteoarthritis (OA). We evaluated the relationship between depressed mood and receipt of mental health (MH) care services. Methods In a cohort with OA, annual interviews assessed comorbidity, arthritis severity, and MH (SF-36 mental health score). Surveys were linked to administrative health databases to identify mental health-related visits to physicians in the two years following the baseline interview (1996-98). Prescriptions for anti-depressants were ascertained for participants aged 65+ years (eligible for drug benefits). The relationship between MH scores and MH-related physician visits was assessed using zero-inflated negative binomial regression, adjusting for confounders. For those aged 65+ years, logistic regression examined the probability of receiving any MH-related care (physician visit or anti-depressant prescription). Results Analyses were based on 2,005 (90.1%) individuals (mean age 70.8 years). Of 576 (28.7%) with probable depression (MH score < 60/100), 42.5% experienced one or more MH-related physician visits during follow-up. The likelihood of a physician visit was associated with sex (adjusted OR women vs. men = 5.87, p = 0.005) and MH score (adjusted OR per 10-point decrease in MH score = 1.63, p = 0.003). Among those aged 65+, 56.7% with probable depression received any MH care. The likelihood of receiving any MH care exhibited a significant interaction between MH score and self-reported health status (p = 0.0009); with good general health, worsening MH was associated with increased likelihood of MH care; as general health declined, this effect was attenuated. Conclusions Among older adults with painful OA, more than one-quarter had depressed mood, but almost half received no mental health care, suggesting a care gap.
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39. Testing the WHO responsiveness concept in the Iranian mental healthcare system: a qualitative study of service users
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Masoumeh Dejman, Miguel San Sebastian, Hassan Rafeiey, Ameneh Setareh Forouzan, and Mehdi Ghazinour
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Adult ,Hospitals, Psychiatric ,Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Psychometrics ,media_common.quotation_subject ,Applied psychology ,Iran ,World Health Organization ,Health informatics ,Health Services Accessibility ,Health administration ,Personhood ,Social support ,Patient satisfaction ,Nursing ,Catchment Area, Health ,medicine ,Humans ,Qualitative Research ,media_common ,Aged ,Health Services Needs and Demand ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Health Policy ,Social Support ,lcsh:RA1-1270 ,Public Health, Global Health, Social Medicine and Epidemiology ,Professional-Patient Relations ,Focus Groups ,Middle Aged ,Patient Acceptance of Health Care ,Mental health ,Focus group ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Socioeconomic Factors ,Patient Satisfaction ,Data Interpretation, Statistical ,Female ,business ,Attitude to Health ,Autonomy ,Confidentiality ,Research Article - Abstract
Background Individuals' experience of interacting with the healthcare system has significant impact on their overall health and well-being. To relate patients' experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This study aimed to assess if the WHO responsiveness concept reflected the non-medical expectations of mental healthcare users in Teheran. Methods In this qualitative study, four mixed focus group discussions were formed, comprising 53 mental health service users in Tehran, Iran, in 2010. Content analysis was performed for data analysis. Responses were examined in relation to the eight domains of the WHO's responsiveness model. Results There were many commonalities between the findings of this study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from our findings. In addition, the domain of prompt attention was included in two new labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity and confidentiality were considered to be important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however. Conclusions The results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in Iran. These findings might help policy-makers' better understanding of what is useful for the improvement of mental health services.
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40. Cultural competence in mental health care: a review of model evaluations
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Kamaldeep Bhui, Nasir Warfa, Kwame McKenzie, Patricia Edonya, and Dinesh Bhugra
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Program evaluation ,Mental Health Services ,Models, Educational ,Service delivery framework ,education ,Patient satisfaction ,Nursing ,Cultural diversity ,Health care ,Medicine ,Humans ,business.industry ,Nursing research ,lcsh:Public aspects of medicine ,Health Policy ,lcsh:RA1-1270 ,Cultural Diversity ,Mental health ,Ethnopsychology ,Patient Satisfaction ,Models, Organizational ,Clinical Competence ,business ,Cultural competence ,Program Evaluation ,Research Article - Abstract
Background Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups. Methods A systematic review that included evaluated models of professional education or service delivery. Results Of 109 potential papers, only 9 included an evaluation of the model to improve the cultural competency practice and service delivery. All 9 studies were located in North America. Cultural competency included modification of clinical practice and organizational performance. Few studies published their teaching and learning methods. Only three studies used quantitative outcomes. One of these showed a change in attitudes and skills of staff following training. The cultural consultation model showed evidence of significant satisfaction by clinicians using the service. No studies investigated service user experiences and outcomes. Conclusion There is limited evidence on the effectiveness of cultural competency training and service delivery. Further work is required to evaluate improvement in service users' experiences and outcomes.
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41. The NSPCC UK Minding the Baby® (MTB) home-visiting programme, supporting young mothers (aged 14–25) in the first 2 years of their baby's life: study protocol for a randomised controlled trial
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Peter Fonagy, Kathryn MacKenzie, Richard Cotmore, Samantha Taylor-Colls, Gwynne Rayns, Richard M. Pasco Fearon, Elena Longhi, Lynne Murray, David Wellsted, and Rachael Hunter
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Time Factors ,Psychological intervention ,Attachment ,Medicine (miscellaneous) ,law.invention ,Study Protocol ,0302 clinical medicine ,Child Development ,Randomized controlled trial ,law ,Pregnancy ,Surveys and Questionnaires ,Adaptation, Psychological ,Pharmacology (medical) ,030212 general & internal medicine ,Social isolation ,Maternal Behavior ,Reflective functioning ,Socioemotional selectivity theory ,Parenting ,Delivery of Health Care, Integrated ,05 social sciences ,Home-visiting programme ,House Calls ,First-time mothers ,Maternal sensitivity ,Child protection ,Research Design ,Child, Preschool ,Pregnancy in Adolescence ,Minding the Baby® ,Female ,medicine.symptom ,050104 developmental & child psychology ,Maternal Age ,Adult ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Mothers ,03 medical and health sciences ,Young Adult ,Intervention (counseling) ,medicine ,Humans ,0501 psychology and cognitive sciences ,Psychiatry ,Primary Health Care ,business.industry ,Infant, Newborn ,Infant ,Social Support ,Mental health ,United Kingdom ,Family medicine ,business - Abstract
Background Young mothers living in low-income urban settings often are exposed to significant and chronic environmental difficulties including poverty, social isolation and poor education and typically also have to cope with personal histories of abuse and depression. Minding the Baby® (MTB) is an interdisciplinary home-visiting programme developed to support first-time young mothers, which integrates primary care and mental health approaches into a single intensive intervention from the last trimester of pregnancy until the child’s second birthday. The primary aim of the intervention is to promote caregiver sensitivity, and, secondarily, to promote both child and maternal socioemotional outcomes. Methods/design This is a multisite randomised controlled trial (RCT) with a target recruitment of 200 first-time adolescent mothers (under 26 years of age). One hundred participants will be randomised to the MTB group and they will receive the MTB programme in addition to the usual services available in their areas. Those participants not allocated to MTB will receive Treatment as Usual (TAU) only. Researchers will carry out blind assessments at baseline (before the birth of the baby), and outcome assessments around the child’s first and second birthdays. The primary outcome will be the quality of maternal sensitivity and the secondary outcomes will focus on attachment security, child cognitive/language development, behavioural problems, postponed childbearing, maternal mental health and incidents of child protection interventions. Discussion This study evaluates the Minding the Baby® programme in the UK. In particular, this RCT explores the effectiveness of this integrative approach, which focusses on maternal mental issues as well as parent-infant interaction, parental concerns and developmental outcomes. Trial registration ISRCTN08678682 (date of registration 3 April 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1618-4) contains supplementary material, which is available to authorized users.
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42. Collaborative learning about e-health for mental health professionals and service users in a structured anonymous online short course: pilot study
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Tobit Emmens, Graham R. Williamson, Ray Jones, Emily J Ashurst, and Jon Perry
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Adult ,Male ,Mental Health Services ,Online discussion ,Higher education ,Adolescent ,lcsh:Medicine ,Pilot Projects ,Education ,Young Adult ,Surveys and Questionnaires ,Medicine ,Humans ,Learning ,Short course ,Cooperative Behavior ,Aged ,Self-efficacy ,Medicine(all) ,Medical education ,lcsh:LC8-6691 ,lcsh:Special aspects of education ,business.industry ,Mental Disorders ,lcsh:R ,Collaborative learning ,General Medicine ,Middle Aged ,Mental health ,Self Concept ,Self Efficacy ,Psychotherapy ,Mental Health ,Webcast ,Therapy, Computer-Assisted ,The Internet ,Education, Medical, Continuing ,Female ,business ,Research Article - Abstract
Background Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs). Adding the 'voice' of mental health service users (MHSUs) in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs. Methods We ran three e-health courses, comprising live interactive webcast, week’s access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs), and Internet self-efficacy and confidence (MHPs) were piloted. Results Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self-esteem and general self-efficacy, all seemed reliable and seemed to show some increase. Conclusions Collaborative learning between MHSUs and MHPs in a structured online anonymous environment over a one-week course is feasible, may be more practical and less costly than face-face methods, and is worthy of further study.
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43. Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care
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Bo S. Runeson, Margda Waern, and Karin M Dahlberg
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Population ,Psychological intervention ,Interviews as Topic ,Middle Eastern Mental Health Issues & Syndromes ,Mentally Ill Persons ,Surveys and Questionnaires ,Medicine ,Humans ,education ,Psychiatry ,Mental health literacy ,Sweden ,education.field_of_study ,Mental health law ,Sex Characteristics ,business.industry ,Public health ,Mental Disorders ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Patient Acceptance of Health Care ,Mental illness ,medicine.disease ,Mental health ,Educational Status ,Female ,business ,Research Article - Abstract
Background Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. Method A postal screening questionnaire was sent to a random sample of the general population aged 20–64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Results Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic. Conclusion Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.
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44. Determinants and patterns of service utilization and recourse to professionals for mental health reasons
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Jean-Marie Bamvita, Guy Grenier, Jean Caron, and Marie-Josée Fleury
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Psychological intervention ,Health administration ,Service utilization ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Catchment Area, Health ,Surveys and Questionnaires ,Health care ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Prospective Studies ,Psychiatry ,Referral and Consultation ,Determinants ,Aged ,business.industry ,Public health ,Nursing research ,Mental Disorders ,Health Policy ,Alcohol dependence ,Quebec ,Middle Aged ,Professionals ,Mental health ,3. Good health ,030227 psychiatry ,Cross-Sectional Studies ,Family medicine ,Female ,Health Services Research ,business ,Research Article - Abstract
Background This study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress. Methods Data was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD. Results Among 243 individuals diagnosed with a MD in the 12 months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12 months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa. Conclusions This study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in healthcare service utilization for MHR. Interventions based on inter-professional collaboration could be prioritized to increase the ability of healthcare services to take care especially of individuals suffering from social phobia, panic disorders and psychological distress. Others actions that could be prioritized are training of family physicians in the treatment of MD, use of psychiatric consultants, internet outreach, and reimbursement of psychological consultations for individuals with low income.
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45. Service user involvement: impact and participation: a survey of service user and staff perspectives
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Marian Barnes, Dee MacDonald, Diana Rose, Mike J. Crawford, and Edward Omeni
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Service delivery framework ,MENTAL-HEALTH-SERVICES ,Attitude of Health Personnel ,Health Personnel ,Population ,Health administration ,DELIVERY ,0807 Library And Information Studies ,Nursing ,Patient and public involvement ,Surveys and Questionnaires ,Health care ,Medicine ,Health services research ,Humans ,Patient participation ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Science & Technology ,business.industry ,Public health ,Health Policy ,CARE ,Middle Aged ,Mental health ,Community Mental Health Services ,PROVIDERS ,CENTERS ,Health Care Sciences & Services ,Cross-Sectional Studies ,England ,1117 Public Health And Health Services ,Patient Satisfaction ,Health Policy & Services ,Female ,Patient Participation ,business ,Life Sciences & Biomedicine ,Research Article ,Service user involvement - Abstract
Background: Over the last 20 years governments around the world have promoted user involvement in an effort to improve the quality of health services. Despite the growing emphasis placed on user involvement in England, there is a paucity of recent studies looking at how service users and professionals perceive the outcomes of user involvement policies. This study aimed to examine the overall levels of participation in service user involvement in mental health services among professionals and service users and ascertain their views on the impact of involvement activity on various areas of service delivery. Methods: A cross-sectional survey of service users and providers within community mental health services. The sampling was carried out across three mental health Trusts, two serving people living in inner-city areas and a third covering a mixed rural/urban population. A questionnaire with closed and open ended questions was used to gather the responses of service users and frontline professionals. As a mixed methods study, the analysis consisted of both quantitative and qualitative approaches. Results: Three hundred and two service users responded to the survey with a response rate of 48%. One hundred and forty three frontline mental health professionals, 26.8% of those approached submitted questionnaires. Almost half of service users (N=138, 45.7%,) and healthcare professionals (N=143, 55.9%) reported having been involved in some form of user involvement activity. Although there were some differences in the responses of service users and frontline professionals, both groups reported that service user involvement was having a positive impact. Conclusions: The findings show that, within the three mental health trusts examined in this study, service user involvement has become widespread and is perceived by both staff and service users to be a good policy. The study had some important limitations. The questionnaire used was based on existing literature, however it was not subjected to psychometric testing. In addition, response rates were low, particularly among professionals. Despite the limitations, the findings are encouraging, offering important of insight into views and experiences of service users and healthcare staff. Further studies are needed to assess and investigate the topic on a national level.
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46. The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients
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Graham Meadows, Ellie Fossey, Frances Shawyer, Elisabeth Wilson-Evered, Grant Russell, Danielle Mazza, Penelope June Weller, Brett Inder, Joanne Enticott, Shiva Vasi, Lisa Brophy, and Vrinda Edan
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Adult ,Male ,Mental Health Services ,Victoria ,law.invention ,Study Protocol ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Nursing ,Recovery ,General Practitioners ,law ,Surveys and Questionnaires ,Intervention (counseling) ,Training ,Humans ,Medicine ,030212 general & internal medicine ,Referral and Consultation ,Primary Care ,Psychiatry ,Protocol (science) ,Data collection ,Primary Health Care ,business.industry ,Mental Disorders ,Quality Improvement ,Mental health ,030227 psychiatry ,Recovery-oriented Practice ,Clinical trial ,Psychiatry and Mental health ,Mental Health ,Cross-Sectional Studies ,Randomized Controlled Trial (RCT) ,Community health ,Female ,business ,Complex Intervention ,Qualitative research - Abstract
General practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues. The intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary care. Recovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project. If findings are positive, the intervention has the potential to extend recovery-oriented practice to GPs throughout the community. Australian and New Zealand Clinical Trial Registry ( ACTRN12614001312639 ). Registered: 8 August 2014.
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47. Mental health: A cause or consequence of injury? A population-based matched cohort study
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Eric Kliewer, Roderick John McClure, Cate M. Cameron, and David M. Purdie
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Adult ,Hospitals, Psychiatric ,Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Population ,Aftercare ,Comorbidity ,Occupational safety and health ,Risk Factors ,Injury prevention ,medicine ,Humans ,Insurance, Psychiatric ,education ,Psychiatry ,Retrospective Studies ,education.field_of_study ,Trauma Severity Indices ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Mental Disorders ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,lcsh:RA1-1270 ,Confounding Factors, Epidemiologic ,Manitoba ,Middle Aged ,medicine.disease ,Mental health ,Hospitalization ,Family medicine ,Cohort ,Wounds and Injuries ,Female ,business ,Research Article - Abstract
Background While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults. Methods The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988–1991) of hospitalised injured cases (ICD-9-CM 800–995) aged 18–64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use. Results Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59). Conclusion These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.
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48. Performance of statistical models to predict mental health and substance abuse cost
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Amy K. Rosen, Maria E. Montez-Rath, Susan L. Ettner, Cindy L. Christiansen, and Susan Loveland
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Male ,Mental Health Services ,Substance-Related Disorders ,Epidemiology ,Normal Distribution ,Health Informatics ,Cost of Illness ,Health care ,Econometrics ,medicine ,Confidence Intervals ,Humans ,Model choice ,Aged ,lcsh:R5-920 ,Actuarial science ,business.industry ,Mental Disorders ,Health services research ,Statistical model ,Health Care Costs ,Middle Aged ,medicine.disease ,Mental health ,Confidence interval ,United States ,Substance abuse ,United States Department of Veterans Affairs ,Ordinary least squares ,Female ,Risk Adjustment ,Health Services Research ,business ,Psychology ,lcsh:Medicine (General) ,Models, Econometric ,Research Article - Abstract
Background Providers use risk-adjustment systems to help manage healthcare costs. Typically, ordinary least squares (OLS) models on either untransformed or log-transformed cost are used. We examine the predictive ability of several statistical models, demonstrate how model choice depends on the goal for the predictive model, and examine whether building models on samples of the data affects model choice. Methods Our sample consisted of 525,620 Veterans Health Administration patients with mental health (MH) or substance abuse (SA) diagnoses who incurred costs during fiscal year 1999. We tested two models on a transformation of cost: a Log Normal model and a Square-root Normal model, and three generalized linear models on untransformed cost, defined by distributional assumption and link function: Normal with identity link (OLS); Gamma with log link; and Gamma with square-root link. Risk-adjusters included age, sex, and 12 MH/SA categories. To determine the best model among the entire dataset, predictive ability was evaluated using root mean square error (RMSE), mean absolute prediction error (MAPE), and predictive ratios of predicted to observed cost (PR) among deciles of predicted cost, by comparing point estimates and 95% bias-corrected bootstrap confidence intervals. To study the effect of analyzing a random sample of the population on model choice, we re-computed these statistics using random samples beginning with 5,000 patients and ending with the entire sample. Results The Square-root Normal model had the lowest estimates of the RMSE and MAPE, with bootstrap confidence intervals that were always lower than those for the other models. The Gamma with square-root link was best as measured by the PRs. The choice of best model could vary if smaller samples were used and the Gamma with square-root link model had convergence problems with small samples. Conclusion Models with square-root transformation or link fit the data best. This function (whether used as transformation or as a link) seems to help deal with the high comorbidity of this population by introducing a form of interaction. The Gamma distribution helps with the long tail of the distribution. However, the Normal distribution is suitable if the correct transformation of the outcome is used.
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49. Estimating the prevalence of depression associated with healthcare use in France using administrative databases
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Anne Fagot-Campagna, Solène Samson, Jean-Paul Fagot, and Antoine Filipovic-Pierucci
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Adult ,Hospitals, Psychiatric ,Male ,Mental Health Services ,Healthcare use ,medicine.medical_specialty ,Databases, Factual ,National Health Programs ,Epidemiology ,Population ,030501 epidemiology ,computer.software_genre ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Prevalence ,medicine ,Humans ,Psychiatric hospital ,030212 general & internal medicine ,Medical diagnosis ,education ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,Health Services Needs and Demand ,education.field_of_study ,Database ,Depression ,business.industry ,Methodology ,Length of Stay ,Middle Aged ,Mental health ,Hospitalization ,Psychiatry and Mental health ,Administrative databases ,Female ,France ,0305 other medical science ,business ,computer ,Algorithms ,Research Article - Abstract
Background Quantitative indicators are needed in order to define priorities, plan policies and evaluate public health interventions in mental health. The aim of this study was to assess the contribution of a large and exhaustive French national administrative database to study and monitor treated depression by comparing the prevalence and characteristics of the population using significant healthcare resources for depression as identified by different estimation methods and sources and to discuss the advantages and drawbacks of these methods. Methods This study included the French population covered by the main health insurance scheme in 2012 (Régime général, 86% of the insured French population). Data were extracted from the French health insurance claim database (SNIIRAM), which contains information on all reimbursements, including treatments and hospital stays in France. The following distinct sources of the SNIIRAM were used to select persons with depression: diagnoses of long-term or costly conditions, data from national hospital claims and data concerning all national health insurance reimbursements for drugs. Results In 2012, we included 58,753,200 individuals covered by the main health insurance scheme; 271,275 individuals had full coverage for depression; 179,470 individuals had been admitted to a psychiatric hospital and 66,595 individuals admitted to a general hospital with a diagnosis of depression during a 2-year timeframe and 144,670 individuals had more than three reimbursements for antidepressants during the study year (with a history of hospitalisation for depression during the past 5 years). Only 16% of individuals were selected by more than one source. Conclusions We propose an algorithm that includes persons recently hospitalised for depression, or with a history of hospitalisation for depression and still taking antidepressants, or with full coverage for depression as a specific long-term or costly condition, yielding a prevalence estimate of 0.93% or 544,105 individuals. Changes in the case selection methodology have major consequences on the frequency count and characteristics of the selected population, and consequently on the conclusions that can be drawn from the data, emphasizing the importance of defining the characteristics of the target population before the study in order to produce relevant results.
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50. THERACOM: a systematic review of the evidence base for interventions to improve Therapeutic Communications between black and minority ethnic populations and staff in specialist mental health services
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Kamaldeep Bhui, Swaran P. Singh, Ala Szczepura, Mark Rd Johnson, Scott Weich, and Rosemarie McCabe
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Mental Health Services ,medicine.medical_specialty ,Psychiatric services ,Mental Health Act ,Ethnic group ,Psychological intervention ,Black People ,BF ,Medicine (miscellaneous) ,HT ,Patient satisfaction ,RA0421 ,Black and minority ethnic patients ,Ethnicity ,Protocol ,Humans ,Medicine ,Cultural Competency ,Healthcare Disparities ,Disengagement theory ,Psychiatry ,Minority Groups ,Interventions ,Receipt ,business.industry ,Communication ,Quality Improvement ,R1 ,Mental health ,Mental Health ,Patient Satisfaction ,Research Design ,Family medicine ,RC0321 ,Therapeutic communications ,business ,Cultural competence - Abstract
Background: Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes.\ud Methods: The THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature.\ud Discussion: A particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661).\ud Keywords: Interventions, Therapeutic communications, Black and minority ethnic patients, Psychiatric services\ud
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