Mental Health Catchment Areas Research Articles

Sex differences in patient-reported outcome measure of psychotic symptoms in schizophrenia.

to study sex differences in self-reported symptoms measured with the Scale of Patient-Reported Impact of Symptoms in Schizophrenia (PRISS), to investigated sex differences in the degree of agreements between self-reported symptoms and clinical symptoms assessed by professionals, and to identify which clinical and sociodemographic variables predicted a greater presence of self-reported symptoms split by sex. 161 patients (37 females; 124 males), aged between 18 and 65 years, with a diagnosis of schizophrenia assisted in non-acute mental health services at four mental health catchment areas in Andalucia and Catalonia were included. The PRISS scale was administered to asses self-reported symptoms. males reported higher presence of excitement, grandiosity, motor retardation and poor attention) than women. There was less agreement in the presence of psychotic symptoms in men than in women when comparing self-reported symptoms and clinical symptoms assessed by professionals. Finally, in men the predictors variables for the greater presence of self-perceived symptoms were greater psychotic symptomatology and more disability, while in women were greater presence of alogia and higher doses of chlorpromazine. Assessing and being aware of the self-perceived symptoms of patients with schizophrenia should be considered in the clinic, especially in men, as there appears to be a lack of agreement on certain items. This would allow treatments to be more focused on patients' need by sex, and would make them feel part of the therapeutic process, improving their therapeutic adherence, evolution and quality of life.

Prevalence of treatment resistant schizophrenia according to minima TRRIP criteria in a mental health catchment area in southern Spain

IntroductionThe response to antipsychotic treatment in patients with schizophrenia varies from 14 to 34% in first episodes, and from 45 to 61% in more chronic patients. Nevertheless, the concept of treatment resistant schizophrenia (TRS) is still a matter of great controversy. Recently, an international group of experts has developed the TRRIP criteria to define treatment resistant schizophrenia (TRS), including an ultra-resistance category for clozapine resistant patients. Up till now, there is a scarcity of epidemiological data of TRS with TRRIP criteria.ObjectivesThis study attempts to identify the population diagnosed of schizophrenia that fulfils the minima TRRIP criteria for TRS in our mental health catchment area.MethodsA descriptive and retrospective study has been developed on the patients diagnosed of schizophrenia (ICD.10, F.20) in the catchment area of the Mental Health Service at Jerez Hospital between 2018 and 2019. TRRIP criteria were applied for two independent researchers and, in case of disagreement, consensus was reached by using the LEAD procedure.ResultsThe total number of ICD-10 schizophrenic patients identified was 590, from a population of 456.752 in 2019. A group of these, 206 patients (35%) qualified as TRS according to the minima TRRIP criteria, 50% were positive subtype and the rest the negative one. 46.8% were treated with clozapine.ConclusionsConsensus criteria of TRS minimise the heterogeneity of epidemiological data in literature. Our data suggest a prevalence rate of TRS lower than that of similar studies. Accordingly, a comprehensive understanding of this population would undoubtedly contribute to improve preventive and therapeutic strategies.DisclosureNo significant relationships.

Patterns of clozapine use, misuse and disuse in a mental health area in southern Spain

IntroductionEvidence supports clozapine as the best treatment in terms of efficacy, effectiveness and well-being, and as the gold standard in treatment-resistant psychotic disorders. Clozapine remains still underused, suffering initiation delays from 1.1 to 9.7 years. Furthermore, there is a scarcity of data about patterns of use, showing high variability worldwide (0.6-189.2/100. 000 inhabitants).ObjectivesThe main objective of this work is to carry out an analysis of the use of clozapine in our mental health catchment area. Thus, off-label use, the percentage of patients with clozapine depending on diagnosis, age and sex, and its use in mono and polytherapy are established. Besides, dosage and time between the first contact and the start of treatment with clozapine are recorded.MethodsA descriptive study has been developed on the patients with clozapine who consulted in the catchment area of the Jerez Mental Health Service between 2018 and 2019. Data were extracted from medical records.ResultsFrom our population of 456.752 inhabitants, 449 patients received clozapine. 278 (61.9%) had a schizophrenia diagnosis; 33 (7.3%) delusional disorder and 34 (7,6%) schizoaffective disorder. The off-label use of clozapine was 19,1 %. The average mean dose used was 246,2 mg/day and 59% of the patients on clozapine were on polytherapy. Only 14,7% of these patients had a previous trial with clozapine on monotherapy.ConclusionsRates of polytherapy, previous trials of clozapine monotherapy, off label use, rates of discontinuation and other variables are to be considered to precisely map the adequate use of clozapine in clinical settings.DisclosureNo significant relationships.

Carer involvement in the transition from inpatient to community mental healthcare: Experiences of stakeholders

IntroductionThe involvement of informal carers (family and friends) in the care of people with severe mental illness (SMI) contributes to positive clinical outcomes, such as relapse prevention and symptom reduction. To date, the care pathway between inpatient and community care is not clearly defined impeding the smooth transition for patients, whilst carers are still barely involved in shared decision-making processes.ObjectivesTo investigate the views and experiences of patients with SMI, carers and clinicians regarding the transition from inpatient to community mental health services.MethodsFour mixed focus groups were conducted with individuals with SMI (n=12), carers (n=10) and clinicians (n=9) across four different mental health catchment areas in England. Participants discussed their experiences and provided their views on facilitators, barriers and solutions for carer involvement during the transition between mental health services. Data were analysed using thematic analysis.ResultsAll stakeholders highlighted that factors that impede carer involvement are related to: confidentiality issues, unmet (structural and organisational) needs, and carer expectations. Patients with SMI, carers and clinicians agreed that carer involvement can be improved by providing psychoeducation to carers and training to staff, having accessible and transparent clinical procedures, and allocating specialised staff to carers.ConclusionsThe study findings emphasise that carer involvement is still overlooked, particularly when adults with SMI transition between services. The results provide guidance for practice emphasising the need for systematic involvement of carers across inpatient care, and for future research proposing effective ways of maximising carer involvement in mental health care.DisclosureNo significant relationships.

Satisfaction with antipsychotics as a medication: the role of therapeutic alliance and patient-perceived participation in decision making in patients with schizophrenia spectrum disorder

Objectives The aim of this study was to identify independent predictors of satisfaction with antipsychotics in patients with schizophrenia spectrum disorders treated in a mental health catchment area. Methods Observational analytical study of patients (n = 150) recruited through a convenience sampling method from five mental health units. Satisfaction with the antipsychotic as a medication was evaluated using the Treatment Satisfaction Questionnaire for Medication (TSQM). Therapeutic alliance was assessed by the Working Alliance Inventory Short Form (WAI-S). Patient-perceived participation in decision-making was assessed using COMRADE (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness). A multiple linear regression analysis was performed to identify variables independently associated with the TSQM ‘Global Satisfaction’ total score. Results Two variables – age and higher level of self-perceived participation in treatment decision-making – were directly, significantly, and independently associated (β coefficient values: 0.209 and 0.432, respectively) with a higher TSQM Global satisfaction score. In addition, the severity of psychotic symptoms was inversely associated with satisfaction (β coefficient value: −0.205) (R 2 = 0.355; R 2 adj. = 0.291; F(13) = 5.554; p < 0.01). Conclusions These findings suggest that involving the patient in treatment decision-making and optimising the treatment to reduce symptoms, especially in younger patients, could increase satisfaction with antipsychotic treatment. Key Points Patient involvement in shared decision-making is relevant for treatment satisfaction. Current evidence suggests that improving the doctor–patient relationship optimises antipsychotics outcomes. Self-perceived participation in decision-making predicts satisfaction with antipsychotic medication. Types of antipsychotics do not determine consistent differences in satisfaction.

Crisis resolution and home treatment: stakeholders\u2019 views on critical ingredients and implementation in England

BackgroundCrisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users’ needs, this study used qualitative methods to investigate stakeholders’ experiences and views of CRTs, and what is important in good quality home-based crisis care.MethodSemi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis.ResultsThree domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users’ experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable.ConclusionsStakeholders’ views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.

In-patient costs of agitation and containment in a mental health catchment area

BackgroundThere is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area.MethodsA mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability.ResultsDuring 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area.ConclusionsAgitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.

Identification and location of hot and cold spots of treated prevalence of depression in Catalonia (Spain)

BackgroundSpatial analysis is a relevant set of tools for studying the geographical distribution of diseases, although its methods and techniques for analysis may yield very different results. A new hybrid approach has been applied to the spatial analysis of treated prevalence of depression in Catalonia (Spain) according to the following descriptive hypotheses: 1) spatial clusters of treated prevalence of depression (hot and cold spots) exist and, 2) these clusters are related to the administrative divisions of mental health care (catchment areas) in this region.MethodsIn this ecological study, morbidity data per municipality have been extracted from the regional outpatient mental health database (CMBD-SMA) for the year 2009. The second level of analysis mapped small mental health catchment areas or groups of municipalities covered by a single mental health community centre. Spatial analysis has been performed using a Multi-Objective Evolutionary Algorithm (MOEA) which identified geographical clusters (hot spots and cold spots) of depression through the optimization of its treated prevalence. Catchment areas, where hot and cold spots are located, have been described by four domains: urbanicity, availability, accessibility and adequacy of provision of mental health care.ResultsMOEA has identified 6 hot spots and 4 cold spots of depression in Catalonia. Our results show a clear spatial pattern where one cold spot contributed to define the exact location, shape and borders of three hot spots. Analysing the corresponding domain values for the identified hot and cold spots no common pattern has been detected.ConclusionsMOEA has effectively identified hot/cold spots of depression in Catalonia. However these hot/cold spots comprised municipalities from different catchment areas and we could not relate them to the administrative distribution of mental care in the region. By combining the analysis of hot/cold spots, a better statistical and operational-based visual representation of the geographical distribution is obtained. This technology may be incorporated into Decision Support Systems to enhance local evidence-informed policy in health system research.

Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective

This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization. Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period. One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care. There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.

Mental health rehabilitation services in Ireland: vision and reality.

The Irish national mental health policy document, A Vision for Change , included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision. A structured questionnaire was sent to consultant rehabilitation psychiatrists in all mental health catchment areas of Ireland that had any rehabilitation services to gather data on various aspects of service provision. Twenty-six of the 31 mental health areas of Ireland had some form of rehabilitation service. Sixteen teams working in 15 of these areas fulfilled A Vision for Change criteria to be defined as specialist rehabilitation services and all 16 responded to the survey. The overall response rate was 73% (19/26). Most services lacked a full multidisciplinary team. Only one service had an assertive outreach team with acceptable fidelity to the assertive outreach model. Urban services were less well resourced than rural services. This is the first national survey to describe the provision of mental health rehabilitation services in Ireland. Although there has been an increase in the provision of consultant-led specialist rehabilitation services nationally, these services lack multidisciplinary input. There also appears to be a lack of planned provision of the facilities required to provide comprehensive rehabilitation services with unequal distribution of resources between urban and rural areas. This has potential cost implications for local mental health services in relation to 'out of area treatment' placements and perhaps more importantly to the overall quality of patient care.

P03-159 - Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective

ObjectivesThis study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.MethodsCase notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.ResultsOne hundred and fifty four new referrals, of whom 41 were non-Irish, presented over a sixmonth period. Results showed no difference between Irish and non-Irish patients in terms of sociodemographic variables. Alcohol problems and subsequent need for detoxification and counseling were significantly increased among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.ConclusionsThere is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilization and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.

The Administration of Psychotropic Medication to Children Ages 0–4 in North Carolina: An Exploratory Analysis

The increasing use of psychotropic medication among preschool children raises concern because there are insufficient clinical guidelines and possible disparities. This study explored published administrative data (2007-2006) on the receipt of psychotropic medication by North Carolina Medicaid enrollees ages 0-4 by mental health catchment area. Quarterly prevalence statistics were examined and potential predictors of receipt were identified for future study. During the study period the state's quarterly prevalence ranged from 2.3 to 3.0 recipients per 1,000 enrollees (range in catchment areas: 0.5 to 9.8). The state rate peaked at 3.0 in the third quarter of 2002 and at 2.9 in the third quarter of 2004. The data are aggregated to a large area level and limited to Medicaid enrollees. The small number of catchment areas (36) limits the utility of statistical associations. Prevalence rates are high enough to deserve further exploration. Geographic variation exists. Psychotropic medication prescriptions for preschool children should be included as the state's mental health practitioners, policymakers, and planners discuss the service system and the mental health of children in our communities.

Trends in Antipsychotic Prescribing in Schizophrenia in Auckland

This study describes antipsychotic prescribing practices for outpatients with schizophrenia over a 3 year period in two large mental health catchment areas of Auckland. All community files were reviewed at three time points. Patient characteristics, diagnosis and antipsychotic treatment information were recorded and analysed. Over the three time periods, the number of outpatients with a diagnosis of schizophrenia or schizoaffective disorder was stable. There was a marked change in the type of antipsychotic prescribed, with an 18.6% increase in atypical antipsychotics and a decrease in both intramuscular and oral typical antipsychotics. Clozapine was the most commonly prescribed antipsychotic in 2003 (35%). Despite the fact that polypharmacy was relatively low (14.6% in 2003), those receiving more than one antipsychotic had a greater likelihood of being prescribed a higher total daily dose. This study describes a change in antipsychotic prescribing towards recommended practice guidelines for the treatment of schizophrenia over a 3 year period.

Developing and maintaining a coordinated system of community-based services to children

The Child and Adolescent Service Systems Program (CASSP) encourages the development of "systems of care" for disturbed children and their families, based on interagency collaboration and community involvement. The experience of the South Shore mental health catchment area near Boston points to several principles for promoting effective collaboration: 1) mobilization of concerned and influential community members, 2) respect for the autonomy and interdependence of systems, 3) appreciation of divergent perspectives, and 4) commitment to shared goals. The realization of these principles depends on certain supports: staff training, flexible agency structure, sanction from a strong community and state and federal legislative support.

Predictors of outcome among adult psychiatric first-admissions

This study comparatively evaluated the prognostic potential of 10 demographic and clinical factors previously associated with psychiatric outcome. The longitudinal design employed intensive, structured, reliable interview techniques. One hundred forty-five subjects from a representative sample (N = 217) of community mental health catchment area first lifetime admissions were assessed at hospitalization and at 2-year follow-up. Predictors examined included premorbid functioning, overall health-sickness, diagnostic severity, social class, sex, age, IQ, race, and life events. Outcome was assessed multidimensionally with absolute-level and residualized indices of functioning and symptomatology. Phillips Premorbid Status and social class emerged from correlation and multiple regression analyses as the best predictors of functioning level and overall clinical status, while IQ was the most prominent indicator of symptomatology changes. Results support the notion that a general social competence factor predicts to psychiatric outcome across the entire spectrum of severe disorders.

Inpatient psychiatric units in nonteaching general hospitals. Response to public mental health policy or hospital economics?

The purpose of the study was to determine the extent to which the existence of inpatient psychiatric units (IPU) in general hospitals is related to patient service "needs," to certain economic and organizational characteristics of general hospitals, or to both. Area and institutional characteristics of general hospitals in Massachusetts were analyzed with multivariate techniques. Interviews were also conducted with representatives from hospitals and the Massachusetts Department of Mental Health in three mental health catchment areas. Most of the teaching hospitals in the state have IPUs. The study indicated that a statistical difference exists between characteristics of IPU and non-IPU nonteaching general hospitals. The probability that a nonteaching general hospital will have an IPU is related to both market conditions and institutional characteristics of the hospital. Nonteaching general hospitals with IPUs were more likely to be located in areas with higher incomes but fewer office-based psychiatrists per capita. IPU hospitals were also more likely to be larger and to receive a higher percent of their revenues from Medicaid than their non-IPU counterparts. The study did not provide evidence that "need" as defined by traditional indicators was an influential factor in IPU existence.

Grants and Outcomes

Grants and Outcomes

The prevalence of adult sexual assault. The Los Angeles Epidemiologic Catchment Area Project.

Data were collected as a supplement to the Los Angeles Epidemiologic Catchment Area project, one of five field sites of a National Institute of Mental Health-initiated program. The authors used a two-stage probability sampling technique to interview 3,132 Los Angeles residents of two mental health catchment areas during the period January 1983-August 1984. Hispanics and non-Hispanic whites were about equally represented in the sample, as were males and females. Respondents were asked, "In your lifetime has anyone ever tried to pressure or force you to have sexual contact? By sexual contact I mean their touching your sexual parts, your touching their sexual parts, or sexual intercourse?" Persons who reported an assault were asked additional questions, including information about the most recent assault. Lifetime prevalence of sexual assault during adulthood (at or after age 16 years) was estimated at 10.5% for the entire sample. Women, non-Hispanic whites, and young people (less than age 40 years) reported higher rates of sexual assault than men, Hispanics, and older people. Highest rates were reported by young non-Hispanic white women with some college education (26.3%). In the most recent sexual assault, three-fourths of respondents knew their assailant, over half experienced harm or the threat of harm, and half experienced sexual contact including but not limited to intercourse.

Social stressors and excess mortality from hypertensive diseases.

Abstract The relation of the social environment to excess mortality from diseases involving hypertension was investigated by correlating demographic, social and economic data with age-sex standardized mortality ratios for these diseases in the 39 mental health catchment areas of Massachusetts. Seventy-nine of the 130 social indicators had significant rank correlations with excess mortality from hypertensive diseases. A broader category of all hypertensive-related deaths correlated with 35 of the social indicators. Death rates were excessive in areas with low occupational status, low median education, widespread poverty, broken families, and substandard housing. This profile of community risk factors parallels closely those for ischemic heart disease, homicide, and deaths due to fire and flames. Quite different social indices are associated with excess mortality due to respiratory diseases and stroke, thus arguing for some specificity of association rather than a general force for all causes of mortality. ...

Phasing Down State Hospitals: Integrated Versus Nonintegrated Services

Two mental health catchment areas in Massachusetts that were in the process of phasing down state hospitals and building up community care provided an opportunity for studying the effectiveness of an integrated service delivery model and a nonintegrated model. The area that integrated state hospital and community services was more successful in the phase-down. It had a lower admission rate, the patients who were readmitted did not stay as long, and patients discharged spent more time in the community. Specific adminstrative and clinical structures that facilitated the patients' progress included investing community-based, administrative authority in one person; having a centralized intake and referral system; and using case managers to follow the clients through the service delivery system.