Organization Of Mental Health Services Research Articles

Psychotherapy of psychotic disorders

Psychotherapy of psychotic disorders Abstract. The efficacy of psychotherapy for individuals with psychotic disorders is well documented and its implementation is recommended by international guidelines. Goals of psychotherapeutic interventions are reduction of symptoms, prevention of relapse, improvement of cognitive, emotional and social functioning, social integration and participation, and enhancement of quality of life as well as self-perception. Cognitive-behavioral and family interventions, cognitive and social trainings as well as psychoeducation are particularly recommended according to the literature. Fundamental factors for a favorable treatment result are a profound therapeutic relationship, a therapeutic setting according to patients' needs, and a specific coordination with other interventions within the individual treatment concept. The implementation of evidence-based psychotherapeutic interventions for individuals with psychotic disorders in clinical routine practice seems to be most challenging for future mental health service organization and research.

OP46 Redefining Mental Health Services For Youth: Evidence To Action

Introduction:Current organization of mental health services in Canada imposes a rupture during youth transition to adulthood, when severe mental health disorders start appearing. This can have a major impact on youth recovery and social integration. A health technology assessment (HTA) was initiated to evaluate the efficacy of programs that simultaneously target adolescents and young adults to support decision making.Methods:A systematic review of systematic reviews was conducted. Four databases were searched (MEDLINE, Embase, Applied Social Sciences Index and Abstracts, and CINAHL) for articles published between 2000 and 2017. Article selection and quality assessment (ROBIS tool) were performed and inter-rater agreement was measured. To be included, the systematic review had to study specialized models or programs serving both adolescents and young adults. An analytical framework was constructed based on the categorization of performance measures for early intervention and the five dimensions of recovery. Group and individual interviews were conducted to collect contextual and experiential data.Results:A total of 1,054 references were identified. After applying the selection criteria, five systematic reviews were selected. The majority of programs identified were developed for early psychosis. This HTA did not identify specialized programs for other types of mental illness or at-risk youth. Evidence on early interventions for psychosis is emerging in regards to their efficacy in improving functional and clinical recovery. However, evidence has yet to be established for their impact on access. Contextual and experiential data from our organization validated and completed the scientific findings. Facilitating and constraining factors in the implementation of a person-centered care model and inter-agency collaboration were identified.Conclusions:Services targeting at-risk youth should be developed as part of a continuum of care that is adapted to clinical stages so that all youths living with psychological distress can be treated, regardless of diagnosis or age. These services may draw inspiration from models of early intervention for psychosis. Recommendations from this HTA are currently being put into action in the West Island of Montreal.

Модернизация психиатрической службы г. Москвы: от гуманизации помощи к развитию общественно ориентированной психиатрии

Background : the main direction of the psychiatric care organization development is the creation of community-based psychiatry system. The basic principles of community-based psychiatry were formulated in international documents regulating the work and organization of mental health services, and consist in providing comprehensive specialized psychiatric care at the primary health care level integrating psychiatric care into general hospitals, creating rehabilitation and home care services, reduction of the inpatient services, use of evidence-based approaches, continuity between inpatient and outpatient psychiatric services, a multidisciplinary approach and observance of mentally ill people rights. Aim : description of Moscow Psychiatric Service modernization, produced in 2010-2018. Material and methods : data of the Psychiatry Organizational and Methodical Department of the Moscow Health Department Order No. 624 of the Moscow Health Department of September, Order No. 753 of the Moscow Health Department and Order No. 130 of the Moscow Health Department. Results : reorganization of the psychiatric services in Moscow from 2010 have been aimed at optimizing of inpatient and development of outpatient levels. The reform of the psychiatric services was carried out in accordance with the Law of the Russian Federation of 02.07.1992 «On psychiatric care and guarantees of the rights of citizens in its provision» and the principles of community-based psychiatry. The first stage of reforms, implemented in 2010-2016, consists of the psychoneurological dispensaries joining to the psychiatric hospitals, the inpatient level reduction and reprofiling of psychiatric hospitals. The second stage, implemented in 2017, included the reorganization of psychiatric hospitals: a further inpatient level reduction and the pooling of psychiatric hospitals. The third stage, planned for 2017-2020, involves the development of outpatient facilities. Conclusions : due to ongoing reforms, the uneven distribution of resources among psychiatric medical organizations in various districts of Moscow has been minimized, the lack of areas for psychiatric outpatient services has been filled, the duration of inpatient treatment has been approximated to the target indications, the structure of the psychiatric outpatient service has been brought into line with the «Order of providing medical care to persons with mental and behavioral disorders».

The organisation of local mental health services in Norway: evidence, uncertainty and policy

This article addresses questions about health authorities’ recommendations on the local organisation of services for people with mental health disorders in Norway. Analysis is made of the dynamic relationship between different evaluations, national guidelines and other knowledge that influence the organisation of services. The analysis is based upon documents about how recommendations by health authorities have shifted during a period of 15 years. The relationship between policy guidelines, the role of scientific evidence and practical organisational models is characterised by ambiguity and pragmatism. Some theoretical implications of these findings and uses of knowledge in different policy areas are discussed.

How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions.

Objectives:Studies on the dynamics between service organization and acute admissions to psychiatric specialized care have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in Norway, we compared a “deinstitutionalized” and a “locally institutionalized” model of mental health services. One had only community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local District Psychiatric Centre.Methods:From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression model.Results:The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377, 95% confidence interval = 4.131–13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582–4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.Conclusion:While it is likely that the seriousness of the patients’ condition is the most important factor in doctors’ decisions to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with local community outpatient services and beds at Central Mental Hospitals.

Socio-demographic and clinical features of patients referred to emergency room psychiatric consultation between 2006 and 2015. A comparison between migrants and natives

In recent decades, Italy has become a desirable destination for immigrants. It should be noted that the organization of mental health services in Italy strongly relies on outpatient services, while the psychiatric wards usually accommodate patients in acute phases of their disorder. Nonetheless, migrants’ first contact often happen in a psychiatry ward when they are in a severe and acute psychopathological condition. The research was performed in the Emergency Department (ED) of the Maggiore della Carità Hospital, Novara, Italy. We collected data about 3781 consecutive patients, 3247 Italian natives and 421 migrants, assessed in the ER of the Maggiore della Carità Hospital, and referred to psychiatric assessment after ER triage. From 1st January 2006 to 31st December 2007, only data for migrant patients were available. From 1st January 2008 to 31st December 2015, data were available for all consecutive patients assessed in the ER. An experienced psychiatrist assessed patients with a clinical interview, including the assessment of suicidal intent, suicidal behaviors and attempts. The psychiatrist filled in for each patient a data sheet, reporting demographic data and clinical features. The high frequency of substance use disorders was higher in the migrant population than in the native one. The request for psychiatric consultation for self-injury behaviors was more frequent in migrants and also suicide attempts were more common. Nonetheless, being a migrant was not a predictor of suicide attempt in our sample.Several differences were found between migrants and natives in socio-demographic, clinical and treatment variables. Clinical implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Forensic care in italy: Changes, illusions and realities

Violence and the risk of violence posed by patients with severe mental illness is a major public health problem for many reasons. Firstly there is the obvious harm to victims, secondly the counter-therapeutic effect on patients of the violence itself, thirdly the restrictive measures typically deployed by services to manage the violence, and finally the significant additional financial cost of these specialist services. Within mental health services the sometimes inaccurate estimate of risk of violence posed by patients can lead to the frequent use of a variety of coercive measures including involuntary hospitalization, enforced medication, restraint and seclusion. These restrictive and costly interventions are almost unanimously perceived as traumatic by the patients and can, in turn, trigger frustration, therapeutic resistance and even aggression instead of treatment adherence and cooperation.Services for the treatment of psychiatric patients who pose a risk of violence are developing and maturing across Europe. New models of care for this extremely complicated multiple needs clinical population exist. However across Europe intervention strategies and service organization and delivery for these patients are very different, and have never been comparatively evaluated. The lack of reliable comparative data has prevented many European countries benefiting from innovative strategies already tested in those countries which have made the greatest efforts in research and service innovation. In this workshop we will compare the organization and functioning of forensic mental health services in different countries; in particular this presentation will inform about the recent changes in forensic mental health services occurred in Italy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Spanish adaptation of the recovery enhancing environments (REE) measure: Preliminary results

IntroductionDuring the last decades, the recovery from severe mental illness has shifted from a focus on reducing symptoms to a more holistic approach of emphasizing consumer-centered goals and subjective wellness (Anthony, 1993). The implementation of this controversial new model it has not had an easy path. In that sense, Ridgway (2004, 2011) developed the Recovery Enhancing Environments (REE), an instrument to gather information on personal mental health recovery and the elements that people feel are important to their recovery; staff activities and an organizational climate that encourages resilience.ObjectiveTo present the preliminary results of the Spanish adaptation.MethodEnglish to Spanish translation of REE was carried out. The REE interview and Euro-Qol5d, HoNOS, EEAG and CGI scales were completed by 312 patients in Mental Health Services organization of Bizkaia (Spain), 189 men and 123 women (age = 48.89). The interviewers of the REE were service users trained and hired for this task.ResultsThe alpha de Cronbach was .98, and for its dimensions: program performance indicators (.97), organizational climate (.92) and recovery markers (.93). The concurrent validity with others scales have resulted in correlations coefficients superiors to r = .35 (P < .001).DiscussionAs the different indicators are adequate and the instrument has a similar structure to other theoretical studies, it can be conclude that Spanish REE is an appropriate measure to fill the gap between the knowledge in the recovery model and what services can do to supports this model. All of this information gathered from people who receive mental health services.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Urban and non-urban differences in community living and participation among individuals with serious mental illnesses

Despite a wealth of studies examining the relationship between urbanicity (i.e., living in an urban area) and psychological distress, there is a paucity of research examining the relationship between urbanicity, community living, and community participation of adults with serious mental illnesses. This study addresses this knowledge gap by assessing urban and non-urban differences in community participation, sense of community, mental health stigma, and perceptions of the neighborhood environment among individuals with serious mental illnesses living independently throughout the United States. A total of 300 individuals with serious mental illnesses recruited from 21 outpatient mental health service organizations in 15 states completed a phone survey about their community living and participation experiences. Urbanicity was examined at two spatial scales (block group and county), and independent-samples t-tests were employed to assess urban and non-urban differences in community living and participation variables. Levels of community participation and perceptions of neighborhood quality and crime were higher in urban block groups; sense of community was higher in urban counties; and perceptions of mental health stigma were higher in non-urban counties. Results inform the methodological literature on best practices for assessing urbanicity, as well as interventions aimed at increasing community participation and improving aspects of the built and social environment that affect individuals who experience mental health distress.

ANALYSIS OF PSYCHIATRIC CARE OF PATIENTS IN THE ST. PETERSBURG I. I. DZHANELIDZE RESEARCH INSTITUTE OF EMERGENCY MEDICINE

The analysis of the organization of mental health services to patients of a multi-profile hospital from 2009 for 2015 is provided. The cliniсo-epidemiological analysis of prevalence, structure of mental pathology among the patients hospitalized in somatopsychiatric department and the center of treatment of sharp poisonings of a multi-profile hospital is carried out. The annual average percent of people who need the mental health services constituted 3.39±0.16% of a total quantity of the patients and victims who are on treatment. The efficiency of use of bed fund of somatopsychiatric department for the long-term period is shown. The considerable prevalence of patients with the organic mental disturbances, frustration connected with acceptance of psychoactive agents, neurotic and somatoform disorders in general structure of mental pathology is established.

Day hospital as an interface between psychiatric hospitals and community

The organization and implementation of mental health services must align with the general evolution of society, with the principles and community values.The continuous creation and development of a balanced care model for patients with psychosis will be possible if are taken into account actions for the evaluation and harmonization of some dimensions as: population needs versus local resources; continuous hospitalization services versus day hospitalization; defining the community role in the context of psychiatric care versus patient-centered care, with respect for human rights. Thus, patients diagnosed with a first episode of psychosis could benefit from specialized multidisciplinary care, in a non-stigmatizing context, that promotes recovery and social reintegration.

REFLECTIVE PRACTICE IN ORGANIZATIONAL LEARNING, CULTURAL SELF-UNDERSTANDING, AND COMMUNITY SELF-STRENGTHENING.

The infant mental health field can amplify its effects when it extends its purview beyond the dyad to the larger contexts in which infants and adult caregivers interact and develop over time. Within health, mental health, education, and other human service organizations, the quality of relationships is a critical variable in the individual-level outcomes that such organizations seek. The goals of this work and the means for accomplishing them are highly dependent on human qualities and interactions that are shaped by organizational processes. In communities, too, processes that shape relationships also strongly influence child-, family-, and community-level outcomes. The Touchpoints approach to reflective practice can guide relational processes among professionals, parents, and infants in organizations and communities that influence these outcomes.

How do general practitioners contribute to preventing long-term work disability of their patients suffering from depressive disorders? A qualitative study.

BackgroundDepression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs’ practices with people experiencing work disability due to depressive disorders and explore how GPs’ work context may impact on their practices.MethodsWe conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs’ practices and highlight impacting factors in their work context.ResultsOur results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs.ConclusionsOur results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0459-2) contains supplementary material, which is available to authorized users.

A mudança percebida pelo usuário do Centro de Atenção Psicossocial frente ao tratamento

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Discussant: Ethical challenges

Europe has undergone considerable economic changes that have an impact on mental health of its citizens; have consequences for the organization of mental health services; and raise ethical issues, such as the distribution of wealth, and equity in access to care. Furthermore, Europe is current undergoing serious economic problems that will produce adverse effects on the mental health of its citizens, among them increase in substance abuse related disorders as well as an increase in suicide.The consequences that economic changes have on mental health relate to the conditions of the particular country, as countries with better health security nets would be less likely to experience adverse effects. Different policy measures may reduce the impact on mental health not only within the health sector, but other sectors of society have to be engaged in the process.The symposium will consider these problems from different selected perspectives.An overview of the impact of economic policies on health services will be followed by a presentation of the important role of international organizations like EPA in outlining the problem and finally a presentation of the initiative Choosing Wisely that focuses on communication between health professionals and patients with recommendations of decisions about the most appropriate care based on the patient's individual situation.Disclosure of interestThe author has not supplied his declaration of competing interest.

Leadership and Implementation of Evidence-based Practices in Health Care Organizations

Making organizations helpful in health care generally means ensuring the delivery of cost-effective approaches to reduce human suffering. Strong leadership can facilitate implementation of innovations and evidence-based health care by fostering an organizational context that is supportive of change, encouraging buy-in from staff, and increasing both implementation fidelity (fidelity to the implementation strategy) and intervention fidelity (fidelity to the clinical intervention). In the current era of health care reform, in which provider accountability for cost-effective intervention is paramount, examining the role of transformational leadership in the implementation process of evidence-based care is critical. Transformational leadership has great potential to support the enactment of changes in health care organizations. In addition, although there has been some criticism, transformational leadership has a great deal of empirical support across settings, cultures, and countries. Despite a growing body of support, there is limited knowledge regarding how organizational culture and climate embedding mechanisms are utilized and how these are a function of or relate to transformational leaders’ influence on followers’ implementation behaviors. Each of the four different studies included in this symposium addresses one or more of these issues related to embedding factors associated with the implementation context. Together, the papers help to advance knowledge about the role of leadership in shaping followers’ attitudes and behaviors about implementation of evidence-based treatment practices in mental health and addiction health service organizations. Each of the four papers relies on unique samples and advanced quantitative and qualitative methods to provide a multifaceted perspective on leadership and implementation, an underresearched area in health care. Together, the papers in this symposium advance implementation science by providing concrete understanding of leadership in real-world health care settings. Implications for methods, theory, and translation of findings into practice are discussed. Leadership and Climates for Implementation of Culturally Responsive and Evidence-Based Practices Presenter: Erick Guerrero; U. of Southern California Presenter: Yinfei Kong; U. of Southern California Presenter: Gina Rosen; U. of Southern California Leadership Intervention to Improve the Implementation of Evidence-Based Health Care Practices Presenter: Howard Padwa; U. of California, Los Angeles Presenter: Lesley Harris; U. of Louisville Organizational Support Moderates the Effect of Leadership on Organizational Citizenship Behavior Presenter: Gregory A. Aarons; U. of California, San Diego Presenter: Mark G. Ehrhart; San Diego State U. Presenter: Elisa Maria Torres; UC San Diego The Effects of Transformational Leadership and Leader-Member Exchange on Attitudes toward Feedback Presenter: Karissa Fenwick; U. of Southern California, School of Social Work Presenter: Kim Brimhall; U. of Southern California

Les dispositifs de délibération en santé mentale et la démocratisation des échanges entre les pairs : le cas de l’assemblée des usagers d’un centre d’attention psychosociale au Brésil

Several mental health public networks in Brazil focus on the participation of a plurality of actors in different collective methods of analysis and co-management of services in order to ensure improved efficiency and greater democratization of social relations. It is clear that the analysis of the effectiveness of these collectives is often done at the expense of the social relations of power they help produce. In other words, it is as if the participatory nature of the devices immediately ensure their democratic potential and their positive impact on the recovery of the users involved.Research is presented that seeks to understand the point of view of the actors involved and to determine whether or not collective spaces for the organization of mental health services contribute to the democratization of social relations that is, the construction of individual and collective capacities for debate, decision and public action. What and how people living with serious mental disorders are protagonists in the design of service and in the struggle for quality public services and how this is involved in their recovery? The research is drawn from an organizational ethnography carried out over nearly one year in Campinas, Brazil in 2012. The research focuses on a case study in a psychosocial care center (CAPS) housing for people living with serious mental disorders. To consolidate the internal validity of the case study, three collecting data techniques were applied: the shadowing over 17 institutionalize methods or devices involved in the organization of services of the CAPS, analysis of documents and forty-seven personal interviews with users, managers and workers. This article focuses on the data from the observation of one of these devices deliberation involving users, the user's assembly, as well as interviews with 15 of these participants. The results highlight how peer exchanges, emerging in the assembly of users and the convivencia space lead to collective mobilization to improve services, social and political involvement, mutual help and to complicity and friendship. These exchanges contribute in fact to the emergence of informal peers support based on affect and critical debate. It is not the assembly of the users, but the circulation of peers, at different times of their institutional courses, in various open spaces that trigger the emergence of exchange slowly building the ongoing process of democratization. In conclusion, such observations expose the importance of creating free open space where peers at different times in their recovery process can circulate and talk together. This circulation tends to encourage informal pair support, friendship and political involvement from the time it is deployed in a plurality of open common areas; that is to say, areas where there is room for spontaneity and for the expression of affects among peers.

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later.

BackgroundUK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services.MethodsA cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074).ResultsAt discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes.ConclusionsThe findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person’s readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.

Assessing and changing organizational social contexts for effective mental health services.

Culture and climate are critical dimensions of a mental health service organization's social context that affect the quality and outcomes of the services it provides and the implementation of innovations such as evidence-based treatments (EBTs). We describe a measure of culture and climate labeled Organizational Social Context (OSC), which has been associated with innovation, service quality, and outcomes in national samples and randomized controlled trials (RCTs) of mental health and social service organizations. The article also describes an empirically supported organizational intervention model labeled Availability, Responsiveness, and Continuity (ARC), which has improved organizational social context, innovation, and effectiveness in five RCTs. Finally, the article outlines a research agenda for developing more efficient and scalable organizational strategies to improve mental health services by identifying the mechanisms that link organizational interventions and social context to individual-level service provider intentions and behaviors associated with innovation and effectiveness.

Patterns of Use in Mental Health Specialised Care: Treated Prevalence in the Portuguese Mental Health Services

1. Introduction As stated by WHO in 2003 the perspective in which services are organised helps to define the effectiveness not only of care but also of access to care. Mental Health Services organisation should be based on principles of accessibility, coordination, continuity, effectiveness and equity of care, in a clear respect for human rights. To do this, service planners and providers have to determine the exact mix of different types of mental health services and the treatment gap levels. 2. Objectives 1. Estimate the treated prevalence of mental disorders in the mental health specialised services. 2. Estimate the existing treatment gap. 3. Methods An analysis of the patterns of use in mental health secondary care services was made using data from the national information health system, compiled by the Directorate General of Health - Information Analysis Unit. 4. Results 22.146 patients were treated in the specialised services for mental health disorders, in 2013. This group represents 1,43% of the total patients treated for all health problems and 0,21% of total population. Average length of stay was 16,46 days. Depression was the main diagnosis in 33% of all patients treated, representing 22% of total inpatient days. 5. Conclusion Taking in account that the global annual prevalence of mental disorders in Portugal is 22,9% and that 6,3% are severe mental disorders, there is still a big treatment gap in Portugal. In addition, depression still accounts for a substantial proportion of patients treated in the specialised services inpatient units.