Abstract
The aim of this paper is to evaluate the effectiveness of community Mental Health Departments in Lombardy (Italy), and analyse the eventual differences in outcome produced by different packages of care. The survey was conducted in 2000 on 4,712 patients treated in ten Mental Health Departments. Patients were assessed at least twice in a year with HoNOS (Health of the Nation Outcome Scales). Data on treatment packages were drawn from the regional mental health information system, which includes all outpatient and day-care contacts, as well as general hospital and inpatient admissions provided by Mental Health Departments. Multilevel growth models were used for outcomes statistical analysis, expressed in terms of change of the total HoNOS score. On the whole, Mental Health Departments were effective in reducing HoNOS scores. The main predictor of improvement was treatment, while length of care, gender and diagnosis were weaker predictors. After severity adjustment, some packages of care proved more effective than others. Appropriate statistical methods, comprehensive treatment descriptions and routine outcome assessment tools are needed to evaluate the effectiveness of community mental health services in clinical settings.
Highlights
Over the last 25 years a community care model for patients with mental disorders has been set up. This psychiatric care model is centred on a community-integrated network of mental health facilities (Community Mental Health Centres (CMHC), Psychiatric Wards in General Hospitals, Residential Facilities and Day-care Facilities) located in the neighbourhood, and coordinated by the Mental Health Department (MHD); this model has nothing to do with mental hospitals
International Journal of Mental Health Systems 2008, 2:10 http://www.ijmhs.com/content/2/1/10 on a large geographic scale are still scarce. An exception to this can be seen in the Australian Mental Health National Outcomes and Casemix Collection (MH-NOCC), in which Burgess et al [3] describe care episodes provided for adults in public mental health services across Australia
Our study revealed that appropriate treatment seems to be provided by the Lombard MHDs: On analyzing the initial total Health of the Nation Outcome Scales (HoNOS) score with the longitudinal adjusted model (Table 3), patients with a low mean severity score were treated with the CLIN package, involving only one professional operator and one facility (CMHC); intermediate severity-scoring patients were given the COMM package, involving several professionals, or the Community – Day-Care (COMM-DC) package, involving CMHCs and Day-Care Centres, while patients with higher severity scores were given the packages involving more complex treatments and several facilities
Summary
Over the last 25 years a community care model for patients with mental disorders has been set up This psychiatric care model is centred on a community-integrated network of mental health facilities (Community Mental Health Centres (CMHC), Psychiatric Wards in General Hospitals, Residential Facilities and Day-care Facilities) located in the neighbourhood, and coordinated by the Mental Health Department (MHD); this model has nothing to do with mental hospitals. International Journal of Mental Health Systems 2008, 2:10 http://www.ijmhs.com/content/2/1/10 on a large geographic scale are still scarce An exception to this can be seen in the Australian Mental Health National Outcomes and Casemix Collection (MH-NOCC), in which Burgess et al [3] describe care episodes provided for adults in public mental health services across Australia. In the present analysis the episodes of care effectiveness were analyzed separately according to episode type
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