Mental Health Care Centers Research Articles

How regulations of multidisciplinary diagnostic settings for children with a neurobiological developmental delay or disorder impact on integration of care: the case of Flanders, Belgium

Introduction: An early and fluent diagnostic trajectory, accessible for every child, is currently not guaranteed in Flanders despite the availability of different types of settings offering multidisciplinary diagnostics for neurobiological developmental delays or disorders NDDD. Regulative, organizational and work practice differences potentially impact on the development of collaborative networks guaranteeing accessible and integrated diagnostics, along the trajectories of children. Methods: Mapping the regulative frameworks at the federal and community levels for specialized multidisciplinary diagnostic teams for children with suspected NDDD in Flanders. Analysis of policy documents and legal frameworks of the centers for ambulatory rehabilitation CAR, centers for developmental disorders CDD, student guidance centers SGC, ambulatory mental health care centers MHC, autism reference centers ARC, ambulatory hospital services for pediatric neuropsychiatry APP. Results: Organizations are currently regulated by Federal or Community regulations. The different organizations providing multidisciplinary diagnostics for NDDD fall under different policy domains mental health, rehabilitation, hospitals, education. Federal regulations are more detailed and regulate more aspect than community regulations. For diagnostics at a CAR or MHC, children have to be referred. The regulations on target group facility for the CAR, ARC and MHC, is pathology-based; on CDD, SGC and APP more generally described. In a CAR, MHC and APP diagnostics aim at support and rehabilitation. Diagnostics at SGC aims at support, referral and coordination. ARC and CDD do clinical classifying diagnostics, referral and further coordination. The ARC uses a standardized protocol for diagnostics. The regulations on team composition numbers and disciplines are set for the CDD and MHC; more detailed rules are set for ARC, CAR, SGC and APP. Discussion: Literature on policy or mandated networks suggests that network approaches help to tackle complex problems, if settings offer complementary services and are mutually dependent to reach societal goals. The current confusion and ineffectiveness in the field is partly affected by regulations that do not promote collaboration and complementarity. Services were historically regulated specifically in different fields sectors. Those regulations do not refer to collaboration or cooperation. For the population, it is not clear what types of service are offered, how they differ from or overlap with each other, or for what purpose different organizations can be consulted. Conclusion: Regulations in public services impact on the organization of services and clinical practice. Current regulations in Flanders are not adapted to support network practice and an integrated way of providing accessible diagnostics along NDDD trajectories. Lessons learned: Current regulative frameworks for multidisciplinary diagnostics of NDDD are not adequately adapted to implement accessible and integrated care. The literature on mandated or policy networks urges to develop supportive regulative frameworks identifying complementarities of the different types of facilities. Limitations: Private, non-subsidized multidisciplinary settings are not included. Suggestions for future research: Additional health service research is needed on differences in organizational practice in the field of multidisciplinary diagnostics of NDDD, affecting network development, and on governance mechanisms supporting the development of integrated care. This should include research on factors affecting the accessibility of services.

Effect of Hardiness Training on Perceived Stress and Ways of Coping among Family Caregivers of Patients with Schizophrenia

Homecare of a patient with schizophrenia is a major issue taxing upon the family caregivers. Family caregivers are the one who are least attended by the health care professionals since the focus of everyone turns to the patients’ treatment and rehabilitation. The real issue happens over time that many of the caregivers experiences mental health issues and the patient turns to be the bystander in hospitals and these cycle continues. Here the mental health care centers have to extent their services to consider the ‘whole family’ as a focus of concern in terms of prevention of mental illness, promotion of mental health and rehabilitation. The current study focuses on the effects of hardiness training on Perceived Stress and Ways of Coping of family caregivers of patients with schizophrenia. The Participants for this study comprised of 100 family caregivers of patients with schizophrenia randomly selected and randomly assigned to the experimental group (50) and the control group (50). Data were collected by administering Perceived Stress Scale and Ways of Coping Scale. After collection of the baseline data and pretest of the study variables, Hardiness Training was given to the Experimental Group for 20 days. Post-test was conducted after two weeks using the same instruments. The collected data were analysed using descriptive and inferential statistics. The result revealed that the mean post-test score of Perceived Stress (X2 = 25.72) was significantly lower than the mean pre-test score of Perceived Stress (X1 =66.04) in the Experimental Group. The participants in the Experimental Group had Positive Ways of Coping as their predominant Ways of Coping, such as accepting responsibility, positive reappraisal, Planful problem solving and seeking social support after hardiness training. The ‘t’ value computed between the mean pre-test scores and the mean post-test scores of Perceived Stress (t =29.513, df-49, p < 0.001) in Experimental Group were statistically significant at 0.001 level. The independent‘t’ test computed between the post-test scores of Experimental and Control Group on Perceived Stress (t =31.68, df-98, p < 0.001) and Ways of Coping (t =19.74, df-98, p < 0.001) were statistically significant at 0.001 level. The findings of the study suggest that Hardiness Training has effects on Perceived Stress and Ways of Coping of the Experimental Group of family caregivers of patients with schizophrenia and can be considered as an effective therapeutic modality.

Charlotte Tassé (1893-1974), a tireless promoter of the French-Canadian nurses model.

A forgotten figure of the history of healthcare as well as Quebec's history, Charlotte Tassé (1893-1974) was a figurehead of the professionalization of Quebecoise nurses. This French-Canadian nurse established and ran two nursing schools, launched and directed a professional reference journal for thirty-five years, actively participated in the development of psychiatric nursing in Quebec, owned and managed one of the most important mental healthcare centers in the country, and also created a new class of nurses in Quebec: practical nurses. One of her main achievements was to establish and defend, with tenacity and persistence and through all her endeavors, a unique nursing model that was specific to Quebec: the French-Canadian nurses model. With its traditional values of care and femininity and avant-gardist representations of the nurses' job, which she dedicated to hospital management, her model contributed to making the history of nurses in Quebec unique and original. This paper focuses on the creation of this model and the active promotion it has benefited from for half a century by recounting, thanks to unpublished archives, the history of Charlotte Tassé's exceptional career.

Facial Emotion Recognition

Emotion is a complex conscious that humans experience as a result of interactions with the environment. The project basically takes in the image, recognises the emotion by fragmenting the image with the deep learning technique using CNN. The tools and framework used here are keras and TensorFlow respectively. Here the facial feeling analysis refers to computing system that makes an attempt to mechanically analyse and recognise facial feeling and facial feature changes from visual data. The image being pre-processed helps for aiming a better quality of image and hence the emotion can be detected in a better way. This project can be used in many fields and one such field is mental health care centre. Patients with bipolar disorders should be treated by adhering the emotional behavior of patient and our project helps in doing the same.

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

ABSTRACTIn 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.

The role of long term care centers in the Polish system of mental health care

Abstract Objective: The aim of this work is to review the role of mental health care center and treatment center specialized in psychiatry in the Polish system of mental health care as a whole. Review: For many years in Poland, the process of transformation of psychiatric care model from the institutional (inpatient setting, most expensive) to community care model (personalized, much cheaper), has been taking place. The effective - coordinated system of community care should significantly improve cooperation in the treatment, while the community forms of health care should ensure full availability, complexity, and continuity of care provision. In many cases, the community support is inadequate and cannot provide patient with care at his home environment. For mentally ill, there may be a need for the use of the long term health care centers specialized in psychiatry. Conclusions: A long term mental health care center specialised in mental health plays an important role in long-term care for the mentally ill. As far as a mental health service user’s perspective is concerned, the continuity of care and treatment in the long term health care center (as a health care unit) appears to be more useful and satisfying compared to a residential home for people with chronic mental illnesses. There is a need for broad discussion on the special place of the long term health care center specialized in psychiatry in the present Polish system of mental health care and on the improving of care pathways between inpatient-, day care-and, community care package.

A cross-continental analysis of weight gain, psychiatric diagnoses and medication use during inpatient psychiatric treatment. The international study on physical illness in mentally ill

Weight gain among psychiatric inpatients is a widespread phenomenon. This change in body mass index (BMI) can be caused by several factors. Based on recent research, we assume the following factors are related to weight gain during psychiatric inpatient treatment: psychiatric medication, psychiatric diagnosis, sex, age, weight on admission and geographic region of treatment.876 of originally recruited 2328 patients met the criteria for our analysis. Patients were recruited and examined in mental health care centres in Nigeria (N = 265), Japan (N = 145) and Western-Europe (Denmark, Germany and Switzerland; N = 466).There was a significant effect of psychiatric medication, psychiatric diagnoses and geographic region, but not age and sex, on BMI changes. Geographic region had a significant effect on BMI change, with Nigerian patients gaining significantly more weight than Japanese and Western European patients. Moreover, geographic region influenced the type of psychiatric medication prescribed and the psychiatric diagnoses. The diagnoses and psychiatric medication prescribed had a significant effect on BMI change.In conclusion, we consider weight gain as a multifactorial phenomenon that is influenced by several factors. One can discuss a number of explanations for our findings, such as different clinical practices in the geographical regions (prescribing or admission strategies and access-to-care aspects), as well as socio-economic and cultural differences.

Neurocognitive dysfunctioning and the impact of comorbid depression and anxiety in patients with somatic symptom and related disorders: a cross-sectional clinical study.

The prevalence and severity of neurocognitive dysfunctioning of patients with somatic symptom and related disorders (SSRD) is unknown. Furthermore, the influence of comorbid depression and anxiety has not been evaluated. This study examines neurocognitive dysfunctioning of patients with SSRD and explores if comorbid depression and anxiety is associated with specific neurocognitive dysfunctioning. Cross-sectional study with consecutive patients suffering from SSRD visiting an outpatient specialty mental health care Centre of Excellence for SSRD. Extensive neuropsychological assessment and assessment of depression and anxiety symptom levels using the Patient-Health-Questionnaire-9 and General Anxiety Disorder questionnaire-7 were performed at intake. Multivariate analysis was performed. The study sample consisted of 201 SSRD patients, with a mean age of 43 years (Standard deviation = 13) years; 37.8% were male. Neurocognitive dysfunction in the domains information processing speed, sustained and divided attention, working memory, verbal and visual memory were reported, compared with normative data. Comorbid depression and anxiety occurred frequently within the sample (75.1% and 65.7%, respectively). Neurocognitive dysfunctioning was worse in patients suffering from comorbid depression [multivariate F (7,161) = 2.839, p = 0.008] but not in patients with comorbid anxiety. Poor neurocognitive performance of patients with SSRD is common and worsens in case of comorbid depression. This may explain treatment dropout of patients with SSRD from neurocognitive behavioral therapy. Research on novel interventions is needed targeting neurocognitive functioning of patients with SSRD, particularly those with comorbid depression.

The comorbidity of Axis I disorders in depressed pregnant women.

Depression during pregnancy is highly prevalent and is associated with increased risk of a variety of negative psychological and medical outcomes in both mothers and offspring. Antenatal depression often co-occurs with significant anxiety, potentially exacerbating morbidities for women and their children. However, screening during the antenatal period is frequently limited to assessment of depression so that other significant comorbid disorders may be missed. Follow-up assessment by clinicians has similarly focused primarily on detection of depressive symptoms. Anxiety, obsessive compulsive disorder, and post-traumatic stress disorder, among others, often go undetected in perinatal care settings, even when depression is identified. Failing to recognize these comorbid diagnoses may lead to inadequate treatment or only partial alleviation of distress. Consequently, screening for and assessment of comorbid disorders is warranted. In this study, 382 pregnant women (M age=25.8 [SD=5.3] years, 85.0% Caucasian) receiving care at a university hospital clinic and Maternal Mental Health Care centers in eastern Iowa and who screened positive for depression on the Beck Depression Inventory completed the Structured Clinical Interview for DSM-IV to assess comorbid mental health symptoms and diagnoses. Overall, findings demonstrate high rates of anxiety disorders among women both with and without current major depression, although depressed women reported higher rates of generalized anxiety disorder and post-traumatic stress disorder. Notably, however, incidence-specific symptoms were comparable across groups. Routine screening of both anxiety and depression during pregnancy should be conducted.

Age-related characteristics of outpatients with anxiety disorders: the Leiden routine outcome monitoring study

Objective: It has been hypothesised that clinically important age-related differences between adults with anxiety disorders exist; this study aims to elucidate these differences.Methods: We analysed data from 1950 outpatients diagnosed with DSM-IV-TR anxiety disorders treated at a Dutch hospital or affiliated mental healthcare centres. Three age-groups (young- (18–25; n = 435), mid- (26–40; n = 788) and older adult (41–65; n = 727)) were compared with regard to social demographic characteristics, diagnostic characteristics, anxiety symptom profile, general psychiatric symptom profile and generic health status, in addition, linear analyses were carried out with age as a continuous variable.Results: Average age was 36.48 years (SD 11.71), 62.8% were female. Significant associations with age emerged for gender, employment, education level, living situation, observed depression, agoraphobia (AP), social phobia, aches and pains, inner tension, sleep, interpersonal sensitivity, observed hostility, physical functioning, role limitations due to physical problems, vitality and bodily pain in categorical and continuous analyses. Self reported hostility was only significant in group-wise comparisons; role limitations due to emotional problems were only significant in linear analyses (all at p < .001).Conclusions: This study identified clinically relevant differences between younger and older adult outpatients with anxiety disorders. Clinicians should take these findings into account, as they may support treatment.

Investigation of the Communication Network Among Mental Health Services: The Case of a Community Mental Health Care Center in Attica

Investigation of the Communication Network Among Mental Health Services: The Case of a Community Mental Health Care Center in Attica

The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews

BackgroundTrauma-related disorders and personality disorders are prevalent in survivors of chronic childhood trauma and neglect. Both conditions have serious consequences for patients, their families, society and public health and a high risk of development of chronicity. However, information on the long term course trajectories is lacking and predictors of course outcome in survivors of chronic childhood traumatization are unknown. The first aim of the current study is to identify two-year course trajectories of pathology in patients with trauma-related disorders and personality disorders. The second aim is to examine predictors of the course, including demographics, clinical characteristics and comorbidities.Methods/designThe study is a naturalistic two-year follow-up of 150 patients consecutively admitted to the trauma treatment program and the personality disorder treatment program respectively at GGZ Friesland, a regular Dutch mental health care center. The only exclusion criterion is insufficient mastery of the Dutch language. Participants will be assessed after 2 years of treatment through measures that have been completed at baseline, including structured clinical interviews to measure childhood histories of trauma and neglect, (symptoms of) trauma-related disorders and personality disorders, and psychological questionnaire measures (e.g., general psychopathology, depressive symptoms and personality features). In addition, participants will complete an evaluation questionnaire to assess medication prescribed and treatment (s) received outside GGZ Friesland between baseline and follow-up. Information about (psychological and pharmacological) treatment received at GGZ Friesland during the follow-up period will be collected from patient files.DiscussionThis study provides insight in the two-year course of (comorbid) trauma-related disorders and personality disorders. Identifying predictors of the course of trauma-related and personality disorders will allow to differentiate clinical profiles and will offer indicators for treatment.

Sociodemographic profile of psychiatric inpatients at a center of mental health care in Brazil

BackgroundThe most prevalent disorders between the chronic diseases are the mental health disorders. Almost 650 million of people in the world suffer of some mental health disorders, which cause serious impact on individual abilities, family relationship and social rehabilitation.AimsWe describe and study the sociodemographic characteristics and the diagnosis of a sample of male and female psychiatric inpatients undergoing treatment in a mental health care center in Brazil.MethodsIt is a descriptive cross-sectional study, carried out with 517 psychiatric inpatients from a Brazilian health institution – IMAS Nise da Silveira. Data was collected from January to December 2014 and occurred through consultation of the patients’ hospital notes. Univariate analysis was used for the data collection and analysis.ResultsOur sample was composed by 52.6% (n = 272) of men and 47.4% of women (n = 245); 50.5% were over 40 years old and have a long time of hospitalization. Overall, 64.6% had schizophrenia; 27.2% mood [affect] disorders; 3.7% mental and behavioural disorders due to psychoactive substance use; 1.4% mental retartation; 0.4% personality disorders; 0.2% disorders of psychological development.ConclusionThe profile could advance the mental health care and rehabilitation of these people. Although could improve public policies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Descriptive study of patients with intellectual disability attended in a community mental health care center

IntroductionThe rate of mental illness among people with intellectual disability is at least 2.5 times higher than in the general population [1].ObjectiveTo describe the clinical and sociodemographic characteristics of all patients with intellectual disability treated in a community mental health care center (CMH) located in a city of 120,000 inhabitants on the outskirts of Barcelona with a high poverty index.MethodsDocuments and patient records were reviewed. Clinical, sociodemographic and other treatment data of patients with intellectual disability treated at the CMH were collected.ResultsThe sample consisted of 118 patients. Mean age: 39.5 (SD: 15), 54% men. 92% single and 23.7% legally incapacitated. 46.6% never completed basic education and 44.1% completed primary school. Employment status: 14.4% unemployed, 14.4% currently active, and 50% pensioned. Patients living mainly with their family (parents:) 86%. 68.6% of patients showed aggressive behavior, but the rate of hospital psychiatric admissions was low (mean: 1.1 (SD: 2.3)). Organic comorbidity: 44.9%. Functionality measured with GAF mean: 45 (SD: 12). Level of intellectual disability was mostly mild (62%). Psychiatric diagnoses were: psychotic disorders: 49.25%, affective disorders: 6.8%, personality disorder: 3.4%, Obsessive-compulsive disorder: 3.4%, autism: 11.9% and other diagnoses: 37.3%. Patients treated with anti-psychotics: 78.8%, anti-depressants: 40.7%, and mood stabilizers: 70.5%.ConclusionsIntellectually disabled patients from our sample showed high comorbidity with psychotic disorders, were highly medicated and often exhibited aggressive behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A spatial decision support system for special health facility location planning in developing regions

Access to healthcare is a determinant of the wellbeing of the people. Planning the location and distribution of health facilities to ensure efficiency and equity in the face of limited resources can be challenging, especially where the type of care requires expensive equipments and specialists. This study attempts to provide a spatial decision support system (SDSS) to select specific locations for provision of mental health care out of existing health centres. The SDSS in this study uses a geographic information system (GIS) and location-allocation models. The data used in the SDSS include the coordinates of the location of the mental health facilities, the coordinates and population of the settlements and data on the roads and footpaths in the study area. The empirical results from the application of the SDSS framework shows that the average distance travelled in the existing configuration of mental health care centres (MHC) could be reduced from 15.3 km to 14 km by adopting a model plan. It is also shown that 74.85% of the settlements are more than ten kilometers from the nearest MHC. In order to minimize travel distance and maximize coverage of the population the minimize facilities, model option of the SDSS shows that 21 facilities are required to ensure that the average travel distance is 9.4km and that 98.6% of the settlements are not more than 20 km from the nearest MHC. Decision makers can use the SDSS discussed in this study to achieve efficiency or equity in the provision of health services. Thus it is hoped that health planners would adopt these techniques and tools to make their location decisions more efficient, reduce inequities and be rational in the use of resources. Key Words: Mental Health Facilities, Spatial Decision Support System, Location Allocation Models, Location Efficiency, Location Equity

Recurrent priapism associated with single dose of paliperidone palmitate: a case report

Priapism is the prolonged and painful penile erection in the absence of both physical and psychological stimulation. Although there are many reported etiological factors, it is frequently attributed to drug use. Here, the development of priapism after a single dose of paliperidone palmitate is reported in the case of a patient. The 55-year old male schizophrenia patient had consulted a mental health care center with the complaint of flare up, and had been put on olanzapine therapy. Since his treatment compliance had been irregular, and given his history of risperidone treatment without side effects, therapy was switched to depot antipsychotics with paliperidone palmitate (150 mg i.m.). On the third day of his therapy the patient consulted our hospital with complaint of painful and prolonged penile erection. Examination and urological tests did not result in any pathology that explain the etiology of priapism, which therefore was attributed to paliperidone palmitate use. Since the priapism episodes repeated three times during his follow up, therapeutic aspiration of the corpora cavernosa and intracavernosal adrenalin injection was carried out. Paliperidone palmitate treatment was switched to quetiapine (200 mg/day). In the following 3-month controls, the patient did not have repeat any episode of priapism. Priapism occurs as a result of the blockage of venous drainage of the corpora cavernosa. The role of the antipsychotic agents in priapism probably involves α-1 adrenergic antagonism resulting in penile vascular dysregulation. To the best of our knowledge, this report is the first on priapism due to paliperidone palmitate action, which is strongly evinced by the repetition of the episodes until the effect of the long acting drug expired.

Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis.

Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP. To examine how the stress and social support shape expressed emotion in the carers of FEP. Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively. Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (β=0.834; p<0.001) and social support did not significantly influence EE (β=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R2=0.761). The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress.

308 Linking Suicide Attempt Patients With Community Support Programs: The Effect of a Crisis Intervention Team Operating in the Emergency Department

According to the World Health Organization (WHO), suicide rates in South Korea are the highest in the world. Suicide prevention is one of the most important public health and social issues in South Korea. To this end, there are many community support programs for patients who attempt suicide or self-harm, with the purpose of reducing re-attempt rates. In line with such trends, the Department of Emergency Medicine (ED) at Korea University Ansan Hospital (KUAH), in conjunction with the Ministry of Health, launched a Crisis Intervention Team (CIT) for suicide attempt patients. This study analyzes the effect of the CIT on community support program linkage for suicide attempt patients that visited the ED. This is a before-and-after analysis, which was conducted in the ED of a tertiary academic teaching hospital in Ansan, Korea. Data on suicide attempt patients was collected using ED medical records and was matched against the database of community mental health care centers, where patients were referred for follow-up. The intervention group was defined as suicide attempt patients visiting the ED from Jan to Dec 2015 and the control group was defined as suicide attempt patients visited the ED from Aug 2014 to July 2015. Before the creation of the CIT, suicide attempt patients were referred to community mental health care centers directly from the ED for counselling after ED discharge. Patients are followed up for at least 8 weeks. Comprised of two social workers, the CIT began active counselling in the ED, with regular contact post-discharge to guide suicide attempt patients to maintain longer-term counselling with community suicide prevention centers. Primary outcome was completion of 8-week follow-up by community mental health care centers. A multivariable logistic regression analysis was used to compared outcome between two groups adjusting for potential risks; sex, age, insurance level, initial mental status, suicide mechanism, ED result. Of the total 47,911 patients visiting ED during the pre-intervention period, 318 (0.7%) patients (control group) attempted suicide, and among the 49,534 patients from the post-intervention period, 360 (0.7%) patients (intervention group) attempted suicide. The most common suicide attempt method was drug ingestion in both groups (control group N=174, 54.7%, intervention group N=197, 54.7%). Completion rates of the 8-week follow-up was 19.6% in the control group and 88.4% in the intervention group. (p<0.001) The adjusted odds ratio (95% confidence interval) of the intervention group compared to the control group for completion of follow up was 6.47 (3.08-13.60). Intervention with the CIT showed higher rates of completion of the 8-week follow-up counselling program provided by community suicide prevention centers. Further study to investigate the long term outcome of the suicide attempt patients is warranted.

Cost-Effectiveness of Group and Internet Cognitive Behavioral Therapy for Insomnia in Adolescents: Results from a Randomized Controlled Trial

To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y. Costs and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4 y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists. Outcome measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses confirmed robustness of results. Internet CBTI is a cost-effective treatment compared to group CBTI for adolescents, although effects were largely similar for both formats. Further studies in a clinical setting are warranted. ID: ISRCTN33922163; trial name: Effectiveness of cognitive behavioral therapy for sleeplessness in adolescents; URL: http://www.isrctn.com/ISRCTN33922163.

Assessment of Patient, Family and Staff Satisfaction in a Mental Health Service

Abstract Psychosocial Care Centers (CAPS) provide care to people with psychiatric disorders and aim to reinsert them into the community. Assessing these services is important to maintaining quality. This study assessed the satisfaction level of 84 patients, 84 family caregivers and 67 professionals from a large center of mental health care center (CAPS-III). Structured interviews were individually held by applying the Satisfaction with Mental Health Services Scales (SATIS-BR) and socio-demographic questionnaires. Overall scores were high for family caregivers and moderate for the patients and professionals. The family caregivers were satisfied with all the service's dimensions; patients were satisfied with help received, and professionals were satisfied with their relationships with co-workers. Patients were dissatisfied with the service's infrastructure, while professionals were dissatisfied with working conditions and infrastructure. The results indicate a need for investment in the service's infrastructure and to improve working conditions.