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Aim: The aim of the study was to evaluate fidelity in first episode psychosis (FEP) teams in Czechia and to gage the feasibility and utility of the process in a mental health system that is undergoing a transformation. Methods: Fidelity assessment was conducted using The First Episode Psychosis Services Fidelity Scale (FEPS‐FS). Fidelity assessment was based on a review of data abstracted from the health records of active clients, program documents, administrative data, and interviews with members of staff. The mean scores were compared across the teams. Feasibility and utility were assessed by program response to their fidelity results. Results: Three FEP teams were involved in the fidelity assessment. Across the 35 items, the mean fidelity score ranged from 2.5 to 3.1. Across the FEP teams, the percentage of the 35 items rated as 4 or 5 (satisfactory or exemplary) ranged from 34.3% to 51.4%. Conclusions: This study provided an opportunity to implement FEPS‐FS and assess fidelity in FEP teams in Czechia. The fidelity assessment also provided a baseline for measuring change. [ABSTRACT FROM AUTHOR]

Introduction: Specialized services for people in early stages of serious mental illness have positive effect on quality of life, general prognosis of the illness and on long-term costs of mental health system. Objective: The aim of the paper is to analyse care being provided by community social care services for clients in early stages of serious mental illness in the Czech Republic. Method: 28 semi-structured interviews with community service providers for people with serious mental illness were conducted. Interviews were focused on methods of interventions for people with serious mental illness and on accessible capacities of care network for the target group. Interviews were analysed qualitatively using thematic analysis. Results: Hospitalization in psychiatric hospital is usually the first contact with mental health services for people in early stages of serious mental illness. Minority of these people is contacted by community social services, although the services struggle with insufficient capacities for work with this target group. Insufficient cooperation with other relevant stakeholders, especially schools and general practitioners, and limited public knowledge about mental illnesses are the barriers for better early detection and early intervention. Discussion: Network of specialized care for people in early stages of serious mental illness is missing in the Czech Republic. Care for this target group is delivered late and most often through hospitalization. Community social services provide interventions similar to those being provided in specialized programmes for people in early stages of serious mental illness abroad. However, due to limited capacities, insufficient network of community services and lack of standardized manuals for this target group it is necessary to continuously develop services for people in early stages of serious mental illness. In context of ongoing psychiatric reform these specialized services could be prospectively implemented into evolving Mental Health Centres. [ABSTRACT FROM AUTHOR]

Introduction: People with psychosis are one of the most vulnerable groups in terms of unemployment, poverty and housing issues. The aim of this paper is to analyse the epidemiological and socioeconomic situation of people with a psychotic disorder in the Czech Republic. Method: The data was gathered from multiple sources including: the epidemiological population study of mental health disorders in the Czech Republic conducted in 2017, registers of Institute of Health Information and Statistics of the Czech Republic, databases of Czech Social Security Administration and a cohort study of people consuming community and inpatient psychiatric services in the Czech Republic conducted in 2015/2016. The data was analysed using descriptive and basic analytical statistical methods. Results: More than 150,000 people in the Czech Republic suffer from psychotic symptoms, from this group less than 50,000 people are treated in an outpatient setting and more than 8,000 people are treated in an inpatient setting annually. The unemployment rate of people with psychotic disorders discharged from hospital setting exceeds 82%. About 63% of people with psychosis who consume community services do not work for at least an hour per month (including sheltered employment). In both groups, more than 90% of people receive a disability pension, which is also the source of their highest income. Approximately 30% of people using community services do not receive more than 8,500 CZK per month. A quarter of this population has an income higher than 12,750 CZK. About half of the people benefiting from community services, also receive family support at the same time. On average, family members provide care for 42 hours per month. Psychotic disorders are a notable cause of newly granted disability pensions and care allowances. Conclusion: Most of the people with psychotic disorders do not receive continuous professional care. Those who do receive care, have severe social problems and live under the poverty level. The system of employment of people with severe mental illness contributes to this situation. This situation is untenable and shows elements of structural discrimination. [ABSTRACT FROM AUTHOR]

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Background: Employment significantly improves the quality of life of people with serious mental illness. However, the effectiveness of different employment models varies. Aims: The aim of this article is to identify approaches towards the employment of people with severe mental illness (SMI) and assess their effectiveness while focusing on both, the practice in the Czech Republic and abroad. Method: A systematic review of meta- analyses and systematic reviews was conducted to identify relevant international experience. Czech data were collected from multiple sources, such as EU documents, annual reports of NGOs and via phone interviews with social service providers. The method of narrative synthesis was used to summarize the results. Results: Up-to-date, the evidence shows that sheltered employment is less effective model of employing people with severe mental illness when compared to the Individual Placement and Support (IPS) model of supported employment. In the Czech Republic, effective employment models that would meet principles of evidence-based practice are provided by a few NGO programmes only and they are not effectively supported at the regional or national level. Discussion: The study shows that less effective models of employing people with mental illnesses are financially and legislatively supported in the Czech Republic. Since the practice does not correspond to the existing evidence, it is desirable to initiate pilot projects that would examine feasibility of the IPS model in the Czech Republic. [ABSTRACT FROM AUTHOR]

Background: Rehospitalization in a year after the first discharge for psychotic disorder is routinely considered as a principal health care outcome. However, there is a lack of data about the rehospitalization rate of people with first-episode psychosis in Central and Eastern Europe where the psychiatric care is predominantly based on inpatient care. Methods: Data from nationwide register of inpatient hospitalizations were analysed. A retrospective analysis of first-ever admitted patients with psychosis (F2 according to ICD-10) in 2014 and younger than 60 years of age was conducted. Descriptive statistics aiming to identify the rehospitalization rate were performed. Results: 1 963 patients with psychosis who were first admitted to psychiatric hospitalization in 2014 and discharged between 2014 and 2016 were identified. Of those, 480 (24,5 %) were readmitted in the first year after the first discharge. 101 (21,0%) of those were readmitted within 14 days, 144 (30,0%) within a month and 241 (50,2%) within a 3-month period after the first discharge. An average time between the first discharge and readmission was 124 days, the mean age of those readmitted was 33 years at the time of first admission. Discussion: This register-based study confirms the existence of the revolving door phenomenon in people with first-episode psychosis in the Czech Republic. Each rehospitalization is a burden not only for a patient, as each hospitalization significantly worsens the overall prognosis, but for the whole psychiatric care system as well. Considering the rehospitalization rate in people with first-episode psychosis, more attention should be paid to the development of services which have a potential to lower the risk of rehospitalization such as early detection and early intervention services. [ABSTRACT FROM AUTHOR]