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Mental Healthcare (mental + healthcare)
Selected AbstractsPsychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?ACTA PSYCHIATRICA SCANDINAVICA, Issue 2006T. Becker Objective:, To report recent findings regarding differences in the provision, cost and outcomes of mental health care in Europe, and to examine to what extent these studies can provide a basis for improvement of mental health services and use of findings across countries. Method:, Findings from a number of studies describing mental health care in different European countries and comparing provision of care across countries are reported. Results:, The development of systems of mental health care in western Europe is characterized by a common trend towards deinstitutionalization, less in-patient treatment and improvement of community services. Variability between national mental healthcare systems is still substantial. At the individual patient level the variability of psychiatric service systems results in different patterns of service use and service costs. However, these differences are not reflected in outcome differences in a coherent way. Conclusion:, It is conceivable that the principal targets of mental healthcare reform can be achieved along several pathways taking into account economic, political and sociocultural variation between countries. Differences between mental healthcare systems appear to affect service provision and costs. However, the impact of such differences on patient outcomes may be less marked. The empirical evidence is limited and further studies are required. [source] Knowledge-based treatment planning for adolescent early intervention of mental healthcare: a hybrid case-based reasoning approachEXPERT SYSTEMS, Issue 4 2007W.M. Wang Abstract: Treatment planning is a crucial and complex task in the social services industry. There is an increasing need for knowledge-based systems for supporting caseworkers in the decision-making of treatment planning. This paper presents a hybrid case-based reasoning approach for building a knowledge-based treatment planning system for adolescent early intervention of mental healthcare. The hybrid case-based reasoning approach combines aspects of case-based reasoning, rule-based reasoning and fuzzy theory. The knowledge base of case-based reasoning is a case base of client records consisting of documented experience while that for rule-based reasoning is a set of IF,THEN rules based on the experience of social service professionals. Fuzzy theory is adopted to deal with the uncertain nature of treatment planning. A prototype system has been implemented in a social services company and its performance is evaluated by a group of caseworkers. The results indicate that hybrid case-based reasoning has an enhanced performance and the knowledge-based treatment planning system enables caseworkers to construct more efficient treatment planning in less cost and less time. [source] Community mental healthcare in England: associations between service organisation and quality of lifeHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2002Justine Schneider Abstract The present authors set out to explore the relationship between different forms of service organisation and quality of life (QoL) for service users. Four mental health trusts and their corresponding social services departments were recruited to exemplify: (1) high and low levels of integration between health and social services; and (2) high and low levels of targeting at users with severe mental health problems. The authors used the Lancashire Quality of Life Profile, and chose their sample size to be able to detect a difference of 0.5 in subjective satisfaction scales. Analysis of covariance was used to investigate the simultaneous impact of variables representing user characteristics, objective and subjective QoL, and service organisation. Two hundred and sixty users selected at random from the active caseloads of mental health services in the four districts were interviewed at time 1 and 232 people were interviewed 6 months later (time 2). No bias was detected in the non-respondents at time 2. The authors found few differences between districts. As in other similar studies, QoL seemed to be stable for the whole sample over time. In 6 months, general satisfaction with leisure increased and the number of people who had been in hospital fell. Negative affect score was the only variable found to be associated with subjective QoL, and no predictors of objective QoL were identified. There was some evidence of better objective outcomes for people in receipt of integrated mental health services. They socialised more, and seemed to have less difficulty accessing police and legal services. The results also suggest that interventions targeted at negative affect could have benefits for subjective QoL. [source] ,Like a friend going round': reducing the stigma attached to mental healthcare in rural communitiesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2002P. Crawford RMN DPSN BA (Hons) PhD Abstract Traditionally, stigma is seen as something that is the fault of the mental health system, and that involves an individual suffering social disapprobation and reduced life chances as a result of having been given a diagnostic label and an identity as a patient as a result of their contact with psychiatric institutions. The present study, based on focus group discussions conducted with users and mental healthcare workers in a rural setting, suggests that this classic conception of stigma does not readily apply to care in the community. First, workers described themselves as actively trying to challenge stigma at an institutional level, as well as being apt to change their own practice to reduce the stigmatizing effect of mental healthcare on their clients and make their presence less conspicuous. The ideal was to be ,like a friend going round'. However, this view included a somewhat passive notion of clients. By contrast, the present investigation showed that clients described themselves in much more active terms as being aware of possible sources of stigma and being inclined to challenge negative attitudes themselves. Future mental healthcare practice could draw upon professionals' stock of knowledge as to how their practice could lead to less stigma and could build upon clients' own strengths to achieve stigma reduction. [source] Multilevel investigation of variation in HoNOS ratings by mental health professionals: a naturalistic study of consecutive referralsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2004R. Ecob Episodes of mental healthcare in specialist psychiatric services often begin with the assessment of clinical and psychosocial needs of patients by healthcare professionals. Particularly for patients with complex needs or severe problems, ratings of clinical and social functioning at the start of each episode of care may serve as a baseline against which subsequent measures can be compared. Currently, little is known about service variations in such assessments on referrals from primary care. We set out to quantify variability in initial assessments performed by healthcare professionals in three CMHTs in Bristol (UK) using the Health of the Nation Outcome Scales (HoNOS). We tested the hypothesis that variations in HoNOS total and sub-scale scores are related to referral source (general practices), healthcare assessor (in CMHTs) and the assessor's professional group. Statistical analysis was performed using multilevel variance components models with cross-classified random effects. We found that variation due to assessor substantially exceeded that due to referral source (general practices). Furthermore, patient variance differed by assessor profession for the HoNOS , Impairment scores. Assessor variance differed by assessor profession for the HoNOS , Social scores. As HoNOS total and subscale scores show much larger variation by assessor than by referral source, investigations of HoNOS scores must take assessors into account. Services should implement and evaluate interdisciplinary training to improve consistency in use of rating thresholds; such initiatives could be evaluated using these extensions of multilevel models. Future research should aim to integrate routine diagnostic data with continuous outcomes to address selection effects (of patients to assessors) better. Copyright © 2004 Whurr Publishers Ltd. [source] Self-reported use of mental health services versus administrative records: should we care?INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2002Dr Anne E. Rhodes Abstract Studies of mental health services have emphasized that people in need are not receiving treatment. However, these studies, based on self-reported use, may not be consistent with administrative records. This study compared self-reports of mental health service use with administrative records in a large representative sample. Respondent reports within the Ontario portion of the 1994/95 Household Component of the National Population Health Survey (NPHS) were individually linked to the provincial mental-health physician reimbursement claims. A total of 5,187 Ontarians, aged 12 years or more, reported on their use of mental healthcare within the NPHS and 4,621 (89%) consented and were successfully linked to administrative records. Comparisons between the two sources identified that the agreement for any use and volume of use was moderate to low and varied according to select respondent characteristics. These differences affected estimates of the associations with use and volume of use. People who reported high levels of distress reported more visits than those who did not and this effect was stronger in the self-reported data. These results suggest that recall bias may be present. Regardless of the definition of care, access for those in need remains a concern despite universal medical insurance coverage. Copyright © 2002 Whurr Publishers Ltd. [source] The relationship between risk and insight in a high-security forensic settingJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2003P. WOODS RMN phDDip Health Care Research It is often intimated amongst practitioners in mental healthcare that clients who display poor insight either into their mental health or behaviour present a greater risk either to themselves or others. This paper reports relationships found between the risk and insight subscales of the Behavioural Status Index. This is an instrument designed specifically for healthcare practitioners to measure health functioning amongst mental health clients, in particular those in forensic mental healthcare. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 patients in two high-security mental health hospitals. Seven factors emerged through factor analysis. The first of these contained all the insight items. Significant differences were found on a number of factors between independent groups. Generally, results indicate that patients on lower dependency wards scored more normatively on the factors, adding to instrument validity. Men were found to score more normatively than women. Clinical practice implications and ongoing European studies examining the use of the instrument in clinical practice and its association with treatment planning are discussed. [source] Onset and relapse of psychiatric disorders following early breast cancer: a case,control studyPSYCHO-ONCOLOGY, Issue 10 2009Catherine Gandubert Abstract Objective: Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM-IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. Methods: A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post-Traumatic Stress Disorder Inventory) over three successive periods, ,before cancer' (from childhood to 3 years before the interview), ,around the cancer event' (the last 3 years including the time of diagnosis and treatment), and ,currently' (the last 2 weeks). Results: Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two-year prevalent cases) and PTSD (7/7) and the re-emergence of MDD (n=21 relapses/28 three-year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2,4 times greater in breast cancer survivors than in controls. Conclusion: Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||