Mental Health Care Sector Research Articles

Implementation of a telemental health service for medical students during the COVID-19 pandemic

Abstract: Introduction: The COVID-19 pandemic can be considered a severely stressful event and trigger negative repercussions on the mental health of medical students, such as psychological distress and the development or worsening of mental disorders, harming the academic, social and professional life of these students. As a result of the interruption of classes and the social distancing measures advocated by health agencies during the pandemic, the mental health care sector for medical students at the Federal University of Rio de Janeiro (UFRJ) needed to cancel the face-to-face care at the Clementino Fraga Filho University Hospital in early March 2020 and think of other forms of mental health care for these students. Experience report: This is an experience report about the implementation of telemental health care for medical students at UFRJ during the pandemic, for the continuity of mental health care program using remote assistance, started in late March 2020. The service is being offered by a team of five psychiatrists, a psychologist and a social worker, all university employees. Discussion: The teleservice has served as an important space for listening and embracement in face of these students’ psychosocial demands, whose challenge consists in overcoming some barriers that hinder the availability of and access to mental health services on the university campus, including the preservation of the doctor-patient relationship, the guarantee of confidentiality and quality, and the offer of a space for mental health care when the physical presence is not possible. Conclusion: Despite the difficulties inherent in the rapid process of implementing this service, the potential of technology to help the population at this critical moment is perceived, especially regarding the attention to the mental health of specific groups, such as medical students. The telehealth represents a potential for learning and change in the ways how the access to care is offered, with the perspective of bringing benefits to the students’ mental health, even after the current period of the pandemic, with the goal of expanding these services to other courses of the UFRJ.

‘Momma bear wants to protect’: Vicarious parenting in practitioners working with disturbed and traumatised children

AbstractPractitioners working with disturbed and neglected children and young people face many practical and personal challenges, including countertransference and secondary trauma reactions. One underexplored area is the practitioner requirement to negotiate with children's parents and to process feelings towards both parents and children. We explore the experiences of female counsellors and psychologists working with children and young adults in the UK mental health care sector, using an inductive thematic analysis. While participants spoke positively about their vocation and satisfaction gained from acting as an agent of change in young people's lives, they also related highly intense emotional work and traumatic accounts, using powerful metaphors to convey the impact of hearing and processing stories, indicating vicarious trauma effects and a strong parental invocation in therapists, including maternal feelings towards some children (‘vicarious parenting’). Some parents were cast as potentially harming a child and obstructing the professional's work. Our paper fleshes out vicarious parenting as a particular form of countertransference.

Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya

BackgroundMental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.Methods/designWe will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale –up.DiscussionThe results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information – a critical gap for addressing a leading global cause of disability.Trial registrationClinicalTrials.govNCT03466346, registered March 15, 2018.

Improvement culture in the public mental healthcare sector: evaluation of implementation efforts

The Danish public healthcare system has been forced to improve performance in terms of better service and lower costs. One regional Danish public healthcare organization has systematically implemented an improvement culture in its psychiatry sector. This research paper contains an evaluation of the organization’s transformation journey towards continuous improvement in psychiatry. The study was based on twenty-five personal interviews, two group interviews and four focus group interviews with centre managers, doctors, psychologists, psychiatrists, nurses and medical personnel in two of the ten psychiatry centres in the region. The objectives of implementing an improvement culture were to create better service for patients and to improve efficiency. Findings indicate that a number of critical success factors and barriers exist in mental healthcare and that even though a number of resources was invested up front, adjustments of the implementation process were needed from centre to centre. Furthermore, the implementation of a lean culture had some positive effects on treatments. In particular, internally, efficiency improved in some areas, creating a common view of what creates value and how to make improvements. Involving different groups of specialists in the implementation of an improvement culture is important. However, the achievement of continuous improvement efforts could be challenging, as results can be difficult to quantify. The novelty of the paper lies in the fact that data is collected from different groups of employees (from both managers’ and employees’ perspectives) on the effects of a full-scale implementation of an improvement culture in public mental healthcare.

Mind the Gap: Information Sharing Between Health, Mental Health and Social Care Services.

Information sharing is key to integrated, collaborative, and continuous care. People with a lived experience of mental illness may access several services across the health, mental health and social care sectors, which creates challenges for information sharing. The health informatics community has traditionally not prioritised social care informatics. However, with the growing role of social care in the lives of people with complex health conditions, now is the time when we must consider the articulation between health informatics and social care informatics in Australia. This paper reports the results of a qualitative study to understand the current context of information sharing between health, mental health and social care services. Interviews and focus groups with nine clinicians, caseworkers and support workers were undertaken. Thematic analysis supported the development of several themes. These include the growing role of social care services, the importance of trust and the challenge created by the complexity of conditions people can present with when accessing social care services. To ensure the growing range of social care services do not get left behind with the increasing digitisation of the Australian health system, the health informatics community should prioritise the inclusion of social care informatics in its scope of practice.

Therapeutic mental health effects perceived by outdoor tourists: A large-scale, multi-decade, qualitative analysis

The mental healthcare sector wants to prescribe outdoor therapies, but as yet lacks outdoor capabilities. The tourism sector has those capabilities, but as yet has not shown therapeutic outcomes. Here, therefore, I reanalyse previously published qualitative datasets, to examine mental health effects perceived by outdoor tourists. Outcomes indicate that nature, eco and adventure tourism enterprises could potentially become certified providers of prescribable outdoor therapies in mainstream healthcare. This represents a large economic opportunity, significantly greater than current investment in outdoor education and recreation. From a healthcare perspective, the analysis presented here provides proof of concept only: clinical testing and medical certification are still required. From a tourism perspective, it indicates an opportunity to apply existing skills, under a different commercial model. From a tourism research perspective, it demonstrates a need for more rigorous research on mental health outcomes, beyond emotional experiences.

Resident Work in High-Support Housing

While feminist political economists have identified social service provisioning as socially reproductive work and have examined its reorganization under neoliberalism, little attention has been paid to the mental health care sector. Furthermore, within feminist political economy scholarship on work in the social service sector, little attention has been paid to the contributions of service users. I address some of these gaps by developing a Mad feminist political economy framework to analyze the unpaid socially reproductive work completed by residents in high-support psychiatric housing in Ontario today.
 Drawing on data from interviews with 23 residents and 15 service providers in high-support psychiatric housing in Ontario, as well as a review of government and non-profit organization documents, I argue that the work done by residents alleviates demands on social service workers in a time of neoliberal restraint, intensified workplace demands, and a heightened focus on service user independence in all aspects of life. I then conclude with recommendations for change.

Successful implementation of self-managing teams

PurposeFollowing health-care organisations, many mental health-care organisations nowadays consider starting to work with self-managing teams as their organisation structure. Although the concept could be effective, the way of implementing self-managing teams in an organisation is crucial to achieve sustainable results. Therefore, this paper aims to examine how working with self-managing teams can be implemented successfully in the mental health-care sector where various factors for the successful implementation are distinguished.Design/methodology/approachThis qualitative case study is executed by analysing 18 interviews within two self-managing teams in a mental health-care organisation located in the Netherlands. A coding process is executed in two steps. The first step is open coding, to make small summarising notes within each interview section. The second step is refocused coding, where the open codes were collected, categorised and summarised by searching for recurrence and significance. The coding process is made visible within a code tree. This code tree formed the basis for writing the findings.FindingsSuccess factors for the implementation of a self-managing team that resulted from this research are a clear task portfolio division, good relationships within the team and a coaching trajectory with attention for a possible negative past.Originality/valueBy having used a specific change management model, the Change Competence Model, it can be concluded that a high change capacity will positively influence the success of a self-managing team in the context of a mental health-care organisation.

A student-facilitated community-based support group initiative for Mental Health Care users in a Primary Health Care setting

Background: South African Mental Health Care (MHC) legislation advocates for supportive rehabilitative services in Primary Health Care (PHC) settings. PHC settings are often understaffed and MHC nurses in these settings overburdened with high patient loads. Alternative cost-effective psycho-social intervention strategies must be explored to supplement the overstrained MHC sector to meet the rehabilitative and supportive needs of service users in community settings. Using a social constructionist epistemology, this study aimed to highlight the value of a community-based support group for MHC users at a Tshwane District Community Health Centre. This was done by exploring the meaning group members attached to the group. The intervention was a collaborative partnership between a local University Psychology Department and the Department of Health, Tshwane District, utilising post-graduate psychology students as group facilitators.Methods: Qualitative research methods were applied. Data were collected using semistructured interviews and a collage-making and storytelling method. Thematic analysis highlighted the main themes representing the meaning the five participants ascribed to the group.Results: The findings suggest that the group offered the participants a sense of belonging and a means of social and emotional support. The group also created opportunity for learning, encouraged mental and physical mobilisation and stimulation, and served as an additional link to professional services. Conclusion: The findings suggest that student-facilitated support groups could offer a viable supplement for offering support to service users in PHC settings. The group assisted MHC users to cope with symptoms, social integration, and participating in meaningful activities as part of rehabilitation services.

Social Representation of Community Therapy in Patients of a Psychosocial Care Center in South Ceará

The decentralization of health care in Brazil, which occurred in the last years since the 1988 constitution, has promoted changes in the mental health care sector. Some proposals for reform in the sector, such as the deactivation of psychiatric hospitals, were implemented. In place of the old asylums, new centers of mental health care emerged, with coexistence in open centers and use of multidisciplinary therapy. Today, the Psychosocial Care Centers called CAPS are already part of the reality of several cities in the country. In Ceará, there were several CAPS in the capital and the interior. In this context of changes also appeared a new therapeutic modality the Community Therapy - TC, implemented by professor Adalberto Barreto, first developed in Fortaleza in Quatro Varas Community, initiating a different approach of attention to mental health. In it the participants help themselves in overcoming their problems, improving their self-esteem and facilitating their return to social life. Our research was carried out with users of the CAPS in South Ceará area, aiming to study the influence of Community Therapy on the treatment of patients. The research was of qualitative character through interviews with users of the CAPS, participants of the Community Therapy. Conclusion: Community Therapy was perceived as positive, a contribution to emotional health. Socialization (environment of meeting with friends, a place of dialogue, where people are willing to listen, moment of fraternization) and a Ressignification (solution of a problem, development, a mental path, attitudes of sad people are softened) of the needs of its users.

A Mixed Methods Evaluation of the Northwest London Integrated Care Pilot

The National Health Services (NHS) within inner Northwest London implemented a transformational change pilot program for integrated care from 2011-13. This pilot focused on two populations within the inner northwest quadrant of London: diagnosed diabetics and the elderly over 75 years of age. An information technology (IT) tool was used to pool data across primary, secondary, community, social, and mental health care sectors in order to assess an integrated approach to care coordination. The network of service providers included: 5 social care services; 3 community care services; 106 primary care practices; 2 mental health facilities; 2 hospitals; and 2 non-profit organizations. Some of the main goals of the pilot were to: improve health outcomes among diabetics and the elderly; improve patient experience; reduce service outcomes such as emergency hospital admissions; create care plans for the targeted populations; and establish multidisciplinary case reviews of high-risk patients with the most complex needs. A mixed methods evaluation was essential for assessing the care process and health outcomes of the pilot. Results of the evaluation will be presented, particularly as they relate to clinical outcomes and quality of care, as well as patient and professional experience throughout the integrated care process.

Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs?

Objective The Partners in Recovery (PIR) program is an Australian government initiative designed to make the mental health and social care sectors work in more coordinated ways to meet the needs of those with severe and complex mental illness. Herein we reflect on demographic data collected during evaluation of PIR implementation in two Western Sydney sites. The aims of the present study were to: (1) explore whether two Sydney-based PIR programs had recruited their intended population, namely people living with severe and persistent mental illness; and (2) learn more about this relatively unknown population and their self-identified need priorities. Methods Routinely collected initial client assessment data were analysed descriptively. Results The data suggest that the two programs are engaging the intended population. The highest unmet needs identified included psychological distress, lack of daytime activities and company, poor physical health and inadequate accommodation. Some groups remain hard to connect, including people from Aboriginal and other culturally diverse communities. Conclusions The data confirm that the PIR program, at least in the two regions evaluated, is mostly reaching its intended audience. Some data were being collected inconsistently, limiting the usefulness of the data and the ability to build on PIR findings to develop ongoing support for this population. What is known about the topic? PIR is a unique national program funded to engage with and address the needs of Australians living with severe and persistent mental illness by facilitating service access. What does this paper add? This paper reports on recruitment of people living with severe and persistent mental illness, their need priorities and data collection. These are three central elements to successful roll-out of the much anticipated mental health component of the National Disability Insurance Scheme, as well as ongoing PIR operation. What are the implications for practitioners? Active recruitment, exploration of self-reported need priorities and routine outcome measurement are essential yet challenging work practices when working with people living with severe and persistent mental illness.

Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center.

BackgroundThis study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service users.MethodsData were compiled for 4,407 individuals with SUDs who were receiving services from an ARC in 2004. The data came from the merging of four databases: the ARC data registry (January 1st, 2004–December 31, 2004), the Quebec Health Insurance Board database (March 31, 2003–April 1st, 2005), the Quebec provincial database for hospitalizations (March 31, 2003–April 1st, 2005), and the Quebec National Institute of Public Health database (2004). Independent variables were grouped according to the Andersen Behavioral Model of Health Services Use: predisposing, enabling and need factors. Generalized estimating equations analyses were performed to assess the influence of individual and neighborhood-level characteristics on high use of services outside the ARC provided by GPs and psychiatrists. Benjamini-Hochberg’s procedure was applied to correct for multiple comparisons.ResultsAbout 97 % of individuals attending the ARC consulted a GP or a psychiatrist during the two-year study period, for a mean of 1.5 consultations per month. Findings revealed that 5 % of the sample made 26 % of all consultations over the two years, and they were defined as high users. No single predisposing factor was associated with high use. One enabling factor significantly increased the risk of being a high user of services from general practitioners and psychiatrists: receiving services at the ARC for three years prior to 2004. Four needs factors, all related to mental health diagnoses (schizophrenia, mood disorder, anxiety disorder, personality disorder), predicted high use of general practitioner and psychiatrist services.ConclusionsThis study found that nearly all individuals with SUDs receiving services from an ARC were users of health services from GPs and psychiatrists outside the ARC. High users most probably accessed them in inpatient settings. No previous study has compared high service users with low and moderate users among individuals with SUDs. Considering that ARCs are treating individuals with complex needs, some of whom make high use of medical professionals, both ARCs and their clients could benefit from increased collaboration and integration between the addictions and mental healthcare sectors.

Execution of a participatory supportive return to work program within the Dutch social security sector: a qualitative evaluation of stakeholders' perceptions.

BackgroundA process evaluation of a participatory supportive return to work program, aimed at workers without a (permanent) employment contract who are sick-listed due to a common mental disorder, revealed that this program was executed less successfully than similar programs evaluated in earlier studies. The program consisted of a participatory approach, integrated care and direct placement in competitive employment. Aim of this study was to get a better understanding of the execution of the program by evaluating stakeholders’ perceptions. In the absence of an employer, the program was applied by the Dutch Social Security Agency, in collaboration with vocational rehabilitation agencies. Together with the sick-listed workers, these were the main stakeholders. Our research questions involved stakeholders’ perceptions of the function(s) of the program, and their perceptions of barriers and facilitators for a successful execution of the program within the Dutch social security sector.MethodsSemi-structured interviews were held with five sick-listed workers, eight professionals of the Social Security Agency, and two case managers of vocational rehabilitation agencies. Interview topics were related to experiences with different components of the program. Selection of respondents was based on purposive sampling and continued until data saturation was reached. Content analysis was applied to identify patterns in the data. Two researchers developed a coding system, based on predefined topics and themes emerging from the data.ResultsAlthough perceived functions of some components of the program were as intended, all stakeholders stressed that the program often had not resulted in return to work. Perceived barriers for a successful execution were related to a poor collaboration between the Dutch Social Security Agency, vocational rehabilitation agencies and healthcare providers, the type of experienced (health) problems, time constraints, and limited job opportunities.ConclusionsFor future implementation of the program, it will be important to consider how a better integration of services by the Dutch Social Security Agency, vocational rehabilitation agencies and the mental healthcare sector can be improved in order to address treatment and vocational needs simultaneously, and to better match the sick-listed worker with the limited opportunities in the Dutch labor market.Trial registrationNTR3563Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2997-x) contains supplementary material, which is available to authorized users.

Stuck in the middle?: A perspective on ongoing pro-competitive reforms in Dutch mental health care

Pro-competitive reforms have been implemented in many Western healthcare systems, of which the Netherlands is a prominent example. While the pro-competitive reforms in the Dutch specialized care sector have drawn considerable academic attention, mental health care is often excluded. However, in line with other segments of specialized care, pro-competitive legislation has formed the core of mental health care reforms, albeit with several notable differences. Ever since mental health services were included in the Health Insurance Act in 2008, the Dutch mental healthcare sector has been in an ongoing state of reform. Numerous major and minor adaptations have continuously altered the services covered by the basic insurance package, the actors responsible for providing and contracting care, and definitions and measurements of quality. Most notably, insurers and municipalities, which are responsible for selectively contracting those providers that offer high value-for-money, seem insensitive to quality aspects. The question whether the Dutch mental health sector has inherited the best or the worst of a competitive and non-competitive system lingers and international policy makers contemplating reforming their mental health sector should take note.

The Social Responsibility of the State to its Citizenry: Performance of the Social Services Delivery in Mental Health Care Sector

The Social Responsibility of the State to its Citizenry: Performance of the Social Services Delivery in Mental Health Care Sector

Embedding Routine Outcome Monitoring in the Operations Management of a Care Pathway for Depression and Anxiety. Case Illustration and Lessons Learned in the Netherlands.

Background Routine Outcome Monitoring (ROM) is a new phenomenon in the mental healthcare system. Its introduction into daily clinical practice has not been straightforward. This study examines practical examples of the embedding of this innovation and its effective acceptance in clinical practice. Method A case history illustrates how ROM was implemented in a large mental health hospital in The Netherlands. During implementation a number of weak points in the implementation process emerged. An intense analysis of the organization of the care process, in the context of care pathways and operations management, offered explanations of what went wrong in this case. Future improvements are suggested from an operations management viewpoint. Results and conclusion For the improved implementation of ROM in the mental healthcare sector implementation must be widely participatory, the process must be continuously monitored, and a leading, well-informed clinician must be appointed as process manager to guide the implementation process.

Mental health related Internet use among psychiatric patients: a cross-sectional analysis.

BackgroundThe Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients.MethodsPatients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons.Results337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%).Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048).The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary.ConclusionsMost psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0368-7) contains supplementary material, which is available to authorized users.

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations assessed in the current study are likely to improve the efficiency of the mental health care sector.

Modular health services: a single case study approach to the applicability of modularity to residential mental healthcare.

BackgroundThe Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they receive to their needs for self-development. Theoretically, modularity might help mental healthcare institutions with this. Modularity entails the decomposition of a healthcare service in parts that can be mixed-and-matched in a variety of ways, and combined form a functional whole. It brings about easier and better configuration, increased transparency and more variety without increasing costs. Aim: this study aims to explore the applicability of the modularity concept to the residential care provided in Assisted Living Facilities (ALFs) of Dutch mental healthcare institutions.MethodsA single case study is carried out at the centre for psychosis in Etten-Leur, part of the GGz Breburg IMPACT care group. The design enables in-depth analysis of a case in a specific context. This is considered appropriate since theory concerning healthcare modularity is in an early stage of development. The present study can be considered a pilot case. Data were gathered by means of interviews, observations and documentary analysis.ResultsAt the centre for psychosis, the majority of the residential care can be decomposed in modules, which can be grouped in service bundles and sub-bundles; the service customisation process is sufficiently fit to apply modular thinking; and interfaces for most of the categories are present. Hence, the prerequisites for modular residential care offerings are already largely fulfilled. For not yet fulfilled aspects of these prerequisites, remedies are available.ConclusionThe modularity concept seems applicable to the residential care offered by the ALF of the mental healthcare institution under study. For a successful implementation of modularity however, some steps should be taken by the ALF, such as developing a catalogue of modules and a method for the personnel to work with this catalogue in application of the modules. Whether implementation of modular residential care might facilitate the transition from intramural residential care to outpatient care should be the subject of future research.