Health Services In Ireland Research Articles

An analysis of 100 referrals for depression from primary care to an adult mental health service.

Improving the interface between primary care and mental health services is a key target in current healthcare policy in Ireland. This study examines the content of referrals from primary care to a community mental health service for apparent depression. We retrospectively reviewed the clinical records of 100 patients with depression who consecutively attended a specialist mental health service in Ireland's midwest region. Records were reviewed for demographic and clinical information provided by the doctor at the time of referral, subsequent service engagement, diagnosis and treatment initiated. There was considerable variation in the content and presentation of information contained in referral letters. Eleven per cent used structured HSE mental health referral forms. Seventy-six per cent of referrals contained clear information regarding name, address, symptoms and treatment previously initiated. Specifically, low mood, biological symptoms of depression and illness severity were documented in 43%, 34% and 27%, respectively. Suicide risk was documented in 20%. More detail was significantly associated with more severe illness. At initial specialist assessment, 71% had commenced antidepressant treatment, with 11% having received an adequate trial of a first antidepressant and 3% an adequate trial of two antidepressants. Two-thirds were diagnosed with mild/moderate depression. Initiation of antidepressant treatment was linked to subsequent diagnosis of depressive illness by mental health services (p < 0.001). Our findings indicate variable referral practices from general practice to mental health in our region. Most referrals were for mild to moderate depression. Poor access to psychological services locally may be a key factor in this phenomenon.

Psychiatric nurses' attitudes towards children visiting their parents in psychiatric inpatient units.

The provision of care for children of parents with a mental health problem is an area that is frequently neglected by health-care practitioners. The aim of the overall study was to explore psychiatric nurses' knowledge of, attitudes and practice towards the support needs of children whose parent has a mental health problem. This paper specifically addresses the views of psychiatric nurses towards children visiting their parent in a mental health inpatient facility. This study employed a self-completion survey design with a sample of 114 registered psychiatric nurses from one integrated mental health service in Ireland. The majority of participants were in favour of children visiting their parent when in hospital, but were of the view that the visiting areas should be away from the main ward location and designed to be child-friendly. Many expressed concerns about the standard of visiting facilities and worried about the potentially negative impact of a visit on the child's well-being. In relation to education on child-care issues, a significant majority of the participants reported not having received any education in the child-care issues identified and, as a likely consequence, rated their knowledge as insufficient. This study highlights the need for further work in the areas of practitioner education, child-friendly visiting facilities, and the development of policy and practice guidelines around children whose parents experience a mental health problem.

‘Show me the money’: improving the economic evaluation of mental health services

Compared with the United Kingdom, mental health services in Ireland are under-funded and under-developed. This may be partly due to the neglect of economic analyses concerning mental health services in Ireland, as few policy makers would invest in the sector without evidence that such investment represents 'value-for-money' economically. Aim The aim of this paper is to highlight how mental health services can conduct economic service evaluations that ultimately will drive the policy-making agenda and future governmental investment. A guide to the economic evaluation of mental health services, based on a narrative review of relevant policy documents and papers, in an Irish context. Three types of economic analyses that can be undertaken within mental health services are outlined: (a) cost-benefit analysis, (b) cost-utility analysis and (c) cost-minimisation analysis. In addition, a newly formulated questionnaire (i.e. the 'EcoPsy 12') is presented. Economic evaluations of mental health services can provide re-assurances to policy-makers that (much-needed) investment in such services is economically viable.

New Evidence Said to Challenge Psychiatry’s Basic Paradigms

Back to table of contents Previous article Next article Professional NewsFull AccessNew Evidence Said to Challenge Psychiatry’s Basic ParadigmsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:12 Jun 2013https://doi.org/10.1176/appi.pn.2013.6b9AbstractNow is the time to rethink the basic ideas shaping psychiatric practice and return to an emphasis on nontechnical concepts, says an eminent psychiatrist from Ireland.Psychiatry is at a crossroads, according to Patrick Bracken, M.D., Ph.D., clinical director of the West Cork Mental Health Service in Ireland, at APA’s annual meeting in San Francisco in May.“Accumulating evidence challenges the current paradigm underlying psychiatric thinking and practice,” said Bracken. The problem lies deeper than just “too many drugs.”“Psychiatry faced three great quests over the last 30 years—the quest for valid classification systems, the quest for biological and psychological causal pathways in mental illness, and the quest for technological treatments used independently of context—and all are falling apart in front of our eyes,” he maintained.Bracken faults the profession’s adherence to what he calls the “technological paradigm,” an approach to understanding psychiatric symptoms and diagnoses mainly as broken mechanisms or processes that need fixing.“These faulty cognitive or emotional processes are modeled in universal causal terms, separated from context,” said Bracken. “This technical approach pushes nontechnical, nonspecific aspects of mental health to the margins.”Psychiatry is not like cardiology, he said. The mind is not simply another organ of the body, but encompasses relationships, values, and meaning.However, the technological paradigm today guides training, service delivery, and research. Perhaps 95 percent of papers published in psychiatry fall into that category, he said.The treatment of depression serves as an example. Antidepressant medications seem to work for about 60 percent to 70 percent of patients, yet little is known about their mechanism of action. “But how the treatment is carried out is as important as which drug is used,” he stated.Furthermore, while cognitive-behavioral therapy (CBT) is a recommended treatment for depression, studies show that specific features of CBT can vary and still benefit patients.“CBT works,” he said. “But what matters is the quality of the relationship between the patient and therapist, whether the patient feels respected, and whether the encounter is meaningful.”Thus, in Bracken’s view, psychiatry needs to move beyond its current technological paradigm.“The public and our medical colleagues are looking at us and asking, what’s going on?” he said. “For three decades, we’ve been telling them that the classification systems are going to be gotten right, the neuroscience is going to be there, that we’ve got the new psychopharmacology.”But that promise is unfulfilled, he believes. “Unless we grapple with the fundamental paradigmatic issues and actually look at what the science is telling us, we are going to be made irrelevant.”Nevertheless, medical knowledge and expertise will remain relevant and vital to overcoming mental illness. “A post-technological psychiatry would not get rid of the theories and treatments we use today but would start to develop a primary discourse out of which choices could be made about what we search for and prioritize, what training our professionals should have and, crucially, what kinds of services we want to deliver,” he said. ■ “Psychiatry Beyond the Current Paradigm,” an article by Bracken and others in the British Journal of Psychiatry, is posted at http://bjp.rcpsych.org/content/201/6/430.full?sid=d0cde91b-f9aa-4092-ad0a-c1c300545dbf. ISSUES NewArchived

The prevalence and ingredient cost of chronic comorbidity in the Irish elderly population with medication treated type 2 diabetes: A retrospective cross-sectional study using a national pharmacy claims database

BackgroundComorbidity in patients with diabetes is associated with poorer health and increased cost. The aim of this study was to investigate the prevalence and ingredient cost of comorbidity in patients ≥ 65 years with and without medication treated type 2 diabetes using a national pharmacy claims database.MethodsThe Irish Health Service Executive Primary Care Reimbursement Service pharmacy claims database, which includes all prescribing to individuals covered by the General Medical Services scheme, was used to identify the study population (≥ 65 years). Patients with medication treated type 2 diabetes (T2DM) were identified using the prescription of oral anti-hyperglycaemic agents alone or in combination with insulin as a proxy for disease diagnosis. The prevalence and ingredient prescribing cost of treated chronic comorbidity in the study population with and without medication treated T2DM were ascertained using a modified version of the RxRiskV index, a prescription based comorbidity index. The association between T2DM and comorbid conditions was assessed using logistic regression adjusting for age and sex. Bootstrapping was used to ascertain the mean annual ingredient cost of treated comorbidity. Statistical significance at p < 0.05 was assumed.ResultsIn 2010, 43165 of 445180 GMS eligible individuals (9.7%) were identified as having received medication for T2DM. The median number of comorbid conditions was significantly higher in those with T2DM compared to without (median 5 vs. 3 respectively; p < 0.001). Individuals with T2DM were more likely to have ≥ 5 comorbidities when compared to those without (OR = 2.82, 95% CI = 2.76-2.88, p < 0.0001). The mean annual ingredient cost for comorbidity was higher in the study population with T2DM (€1238.67, 95% CI = €1238.20 - €1239.14) compared to those without the condition (€799.28, 95% CI = €799.14 - € 799.41).ConclusionsIndividuals with T2DM were more likely to have a higher number of treated comorbid conditions than those without and this was associated with higher ingredient costs. This has important policy and economic consequences for the planning and provision of future health services in Ireland, given the expected increase in T2DM and other chronic conditions.

Book review: The Challenge of change: putting patients before providers

THE CHALLENGE OF CHANGE: PUTTING PATIENTS BEFORE PROVIDERS BRENDAN DRUMM Orpen Press, 2011 PB, 280pp, £15.00, 9781871305265 The Challenge of Change provides interesting reading. As Chief Executive Officer of Ireland's Health Services Executive, Professor Brendan Drumm had 5 years to attempt much needed reform. The stage set is Ireland but the script is worldwide. He provides a rare insight into the machinations of health services delivery often threading a fine balancing act between political masters, the aspirations of a general public with parochial interests, and an unyielding bureaucracy long accustomed to doing things its own way. Drumm sought to merge ‘hospital and community services into one operational structure with a single management system.’ He saw the exclusion of clinicians from central managerial …

Home-based treatment and psychiatric admission rates: Experience of an adult community mental health service in Ireland

Objectives. This study assessed the impact of the introduction of a Home-Based Treatment (HBT) Service on hospital admission rates from two adjacent sectors within a mental health service. Methods. This study used a naturalistic design to compare admissions into the acute inpatient psychiatric unit of Cavan General Hospital from two differently configured sectors - East and West Cavan Psychiatric sectors (East was a community-based and oriented service while the West was a more hospital-based service) prior to and following the introduction of a shared home-based treatment team. Data including demographics, date of admission, diagnosis at admission and sector of admission were retrospectively collected from a mental health register of hospital admissions between 1995 and 2002. Data was analysed using SPSS version 13 for windows. Results. There was a 50% reduction in admission to the inpatient unit in the first two years of the introduction of HBT. This drop was more marked in the West sector compared to the East. Conclusions. The introduction of HBT resulted in a marked reduction in overall hospital admission rates and this reduction was also evident in the sector where other elements of a modern community mental health service already existed.

Supporting children whose parent has a mental health problem: an assessment of the education, knowledge, confidence and practices of registered psychiatric nurses in Ireland

Health professionals, including nurses, stand accused of ignorance or oversight of children whose parent experience a mental health problem. Psychiatric nurses are in an ideal position to respond to children's needs and support their parents in a proactive and sensitive manner. The aim of this study was to explore psychiatric nurses' education, knowledge, confidence and practice with regard to the support needs of children whose parent has a mental health problem. This study employed a self-completion anonymous survey design with a sample of registered psychiatric nurses from one integrated mental health service in Ireland. The sample reported relatively low levels of education, knowledge, confidence and supportive clinical practice when it came to children whose parent has a mental health problem. There is an urgent need for education on family-focused care, and the development of guidelines and child focused services if the needs of parents and children are to be met.

A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland

The international literature points to the specific cancer risks and palliative care needs of lesbian, gay and bisexual (LGB) populations. However, with the exception of a programme in the USA, there is a lack of training internationally for health and social care professionals providing oncological and palliative care to LGB patients. In Ireland, a training project funded by the Irish Cancer Society, the Irish Hospice Foundation and the Health Service Executive developed a training pilot programme for health and social care professionals providing oncological and palliative care to LGB patients. Over 200 (N = 201) oncology and palliative care staff participated in 17 brief, 50-min trainings in pilot sites. Evaluation of the training included self-report questionnaires at the end of each training and an evaluation interview with one participant from each of the four sites. The majority of participants reported that they would recommend the training to their colleagues, were interested in further training in the area and found the training useful for their practice. They also reported becoming more familiar with LGB-related language and terminology, became more knowledgeable of LGB health issues and reported becoming more confident in providing care to LGB patients. Recommendations are that the training be made available across the health services in Ireland and included in postgraduate courses for trainee health and social care professionals.

A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness

There is increasing interest in the application of recovery principles in mental health services. We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in a community mental health service in Ireland. Eighty service attenders with severe and enduring illness characterized by significant ongoing disability were randomized into (1) a group receiving a programme of ICM and (2) a group receiving treatment as usual (TAU). Groups were compared before and after the programme for general psychopathology using the Brief Psychiatric Rating Scale (BPRS) (clinician rated) and How are You? scale (self-rated). The Functional Analysis of Care Environments (FACE) scale provided assessment of multiple functional domains. The overall group (mean age 44.5 ± 13.2 years; 60% male) had mean total Health of the Nation Outcome Scale (HoNOS) scale scores of 10.5 ± 4.6, with problems in social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p < 0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p < 0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01). A programme of ICM emphasizing recovery principles resulted in significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.

Health, Employment and the Quality of Life in Ireland

The purpose of this paper is to investigate the determinants of the Quality of Life (QoL) in Ireland using a sample of 3,500 respondents to the Irish Health Service Executive's Survey of Consumers' Experience of the Health Services in Ireland (HSE Survey) carried out between November 2006 and March 2007. Using an ordered logit model, we show that the likelihood of being satisfied with one's QoL is enhanced by social class, income, employment and, above all, by health. The methodology's ability to identify persons who might be ‘at risk’ from a low QoL allows one to speculate on the QoL in Ireland today, in the winter of its discontent, compared to that in 2006–07 when it basked in the summer of the Celtic Tiger. In present circumstances, one would expect that joblessness would play a much more important role in determining QoL: prior to 2008, unemployment meant a short wait till a suitable job turned up; now it is more likely to involve either a protracted search at home or emigration. Furthermore, since unemployment often leads to bad health outcomes, one can be reasonably certain that the QoL associated with a 14 per cent unemployment rate will be considerably worse than those witnessed during the halcyon days of the economic boom. This raises the question of how this additional, recession-induced demand for health services will be met at a time when public expenditure on health in Ireland is to be cut by €1.4 billion over the next four years.

Does Ownership Affect the Provision of Health Services in Ireland? – The Case of Hip Replacements in Public and Private Clinics

This paper examines how ownership affects professional behaviour, treatment quality and patient satisfaction in the case of hip replacements in Ireland. We use quantitative data for public hospitals and the author’s own surveys for the private sector and qualitative data from 12 interviews, following the methodology of Andersen and Jakobsen (2010). We find that patient satisfaction is higher in the private sector though the private sector has fewer patients with complications. The surgeons’ choice of operating environment is made in light of the back-up facilities available and not influenced by economic considerations. The treatment in both sectors is identical and there is no difference in clinical outcomes due to the professional norms of the consultant surgeons. Ownership of facilities does not affect the clinical outcomes in provision of hip replacements in Ireland.

NVivo 8 and consistency in data analysis: reflecting on the use of a qualitative data analysis program

Qualitative data analysis is a complex process and demands clear thinking on the part of the analyst. However, a number of deficiencies may obstruct the research analyst during the process, leading to inconsistencies occurring. This paper is a reflection on the use of a qualitative data analysis program, NVivo 8, and its usefulness in identifying consistency and inconsistency during the coding process. The author was conducting a large-scale study of providers and users of mental health services in Ireland. He used NVivo 8 to store, code and analyse the data and this paper reflects some of his observations during the study. The demands placed on the analyst in trying to balance the mechanics of working through a qualitative data analysis program, while simultaneously remaining conscious of the value of all sources are highlighted. NVivo 8 as a qualitative data analysis program is a challenging but valuable means for advancing the robustness of qualitative research. Pitfalls can be avoided during analysis by running queries as the analyst progresses from tree node to tree node rather than leaving it to a stage whereby data analysis is well advanced.

Service user involvement in mental health practitioner education in Ireland

In recent years, there is an ever increasing call to involve people who use mental health services in the development, delivery and evaluation of education programmes. Within Ireland, there is very little evidence of the degree of service user involvement in the educational preparation of mental health practitioners. This paper presents the findings on service user involvement in the education and training of professionals working in mental health services in Ireland. Findings from this study indicate that in the vast majority of courses curricula are planned and delivered without consultation or input from service users. Currently the scope of service user involvement is on teaching, with little involvement in curriculum development, student assessment and student selection. However, there is evidence that this is changing, with many respondents indicating an eagerness to move this agenda forward.

The emergence of a dual diagnosis pathway within a primary care setting in Cork, Ireland

This paper outlines current developments in a local health service in Ireland. It involves the integration of its mental health and addiction services, within the context of a primary, community and continuing care (PCCC) setting. The paper describes how the transformational process was initiated and how the clinicians embraced the opportunity of the co‐location of services to advance the assessment and treatment of dual diagnosis.

A potential model for primary care mental health services in Ireland.

A high demand for the inclusion of psychosocial interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlighting principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care service delivery models for mental health presentations and to contribute towards future planning initiatives. A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context. The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service structures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clinically- and cost-effective, equitable and accessible service driven by service user and carer input. Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication.

Leadership and service user empowerment in mental health services in Ireland

Leadership and service user empowerment in mental health services in Ireland

‘I send the wife to the doctor’– Men's behaviour as health consumers

AbstractThis paper explores men's behaviour and attitudes in relation to health matters. While there has been some practical and research progress in engaging with users of health services, there is less development in the area of engaging non‐users. In effect, all members of the society can be the consumers/users of health promotion, though not all are. This paper reports on the first stage of a wider project aimed at increasing the effectiveness of skin cancer awareness messages aimed at men. The project focuses on men over 50 from an area of socio‐economic disadvantage, since these men tend to have the lowest life expectancies in general, and the highest incidences of mortality for skin cancer both at a national and international level. The research was conducted through community‐based focus groups and while the sample was relatively, small it produced some interesting outcomes in terms of how this cohort audited and responded to public health promotion campaigns; how they perceive cancer and health issues in general; how they respond to health issues; and how they view both the public health service in Ireland and the ways health professionals relate to them. It confirms many theories about how men view their health and how they respond to health promotion campaigns. Among other points, it raises questions about the possible mixed benefits of testimonial‐based advertising. It also indicates that there may be further layers of complexity connected to identity, fatalism, problem solving and respectful treatment that have not been sufficiently articulated in the literature. It points to the need for greater engagement by service planners and providers with the needs of their target audience, which may require a more encompassing definition of service user.

Patient attitudes towards compulsory community treatment orders and advance directives.

The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan. Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI). Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan. With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.

The role of the public health nurse in a changing society

This study is a report of a study to clarify the role of the public health nurse in one Irish community care area in the light of acknowledged problems in defining boundaries of the role. Demographic developments and planned reorientation towards primary care of the health service in Ireland have changed the workload of public health nurses, which is unique compared with other countries. However, there is a lack of clarity and consequent problems in defining the role of the Irish public health nurse. A descriptive qualitative study was conducted with 25 representatives of community nursing from one county in Ireland with a population of 209,077 and a complement of 65 full-time equivalent public health nurses. Purposive sampling was used and 21 public health nurses, two registered general nurses, one assistant director and one school nurse participated. Tape-recorded, individual semi-structured interviews were conducted over a 15-month period from 2002 to 2004. The constant comparative method was used for analysis. Four themes emerged: 'Jack of all trades: the role of the public health nurse defined and described', 'the essence of the role', 'challenges to the role of the public health nurse' and 'communication'. The first theme is discussed in this paper. Public health nurses need to define and redesign their role so that they no longer think that they are the catch-all service in the community. This will enable them to deal with the rapid demographic, sociological and cultural changes in the population, a change that has international resonance.