Quality Of Psychiatric Services Research Articles

IPS: Where We Connect, Equip, and Inspire

Back to table of contents Previous article Next article From The PresidentFull AccessIPS: Where We Connect, Equip, and InspireAltha StewartM.D.Altha StewartSearch for more papers by this authorM.D.Published Online:10 Jan 2019https://doi.org/10.1176/appi.pn.2019.1b26If you joined APA before 1995, you probably remember when the Institute on Psychiatric Services (IPS) was known as the Institute on Hospital and Community Psychiatry. In 2015, it was renamed IPS: The Mental Health Services conference. Regardless of its name, since its beginnings 70 years ago, it has been the meeting where many APA members who work primarily in publicly funded settings connect with their colleagues, gain the latest knowledge and skills to maintain the highest standards of care, and are inspired to continue doing this work and encourage others to join them.More than just a feel-good meeting, the IPS has, from its inception, been driven by the core values and mission of APA: “to improve access to and quality of psychiatric services” for “individuals with mental illnesses, including substance use disorders, and their families.” Held each fall, it is designed to be a smaller, intimate experience different from the Annual Meeting and serves as APA’s tangible commitment to supporting the work of psychiatrists on the frontline who are committed to ensuring that as many people as possible, regardless of their circumstances, have access to high-quality mental health care.This commitment to community psychiatry is also apparent in other areas of the organization, notably the $14.2 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to create the Clinical Support System for Serious Mental Illness (Psychiatric News, July 27, 2018). We have also increased our focus on training and developing public sector psychiatrists, thanks to APA’s taking the lead in the SAMHSA-funded Recovery to Practice Training Curriculum. Today, community psychiatry is being called “the third psychiatric revolution,” and as this nation’s oldest medical association with roots deeply embedded in providing public-sector care, APA is uniquely positioned to provide the support and educational programs that community psychiatrists need to continue their work and move it forward.Unfortunately, the IPS has floundered over the last few years because of increasing expenses associated with hosting meetings in major cities and decreasing revenue from registration and exhibitors. As a part of our fiduciary responsibility to the organization, Dr. Anita Everett appointed and I have continued the IPS Strategic Planning Work Group, charged with conducting a situational analysis of the meeting (examining its structure, duration, location, and timing) and making recommendations for enriching the meeting over the next three to five years.As with other areas of the Association, we are looking at ways to improve operations while providing high-quality member benefits to our growing organization. The work group submitted its initial recommendations to the Board of Trustees at its December 2018 meeting, and after accepting the work group’s initial report, the Board requested that the work group continue and work with APA staff to evaluate the feasibility of a revised format for future IPS meetings. They will report back to the Board in March. The Board also voted to not hold the IPS in 2020 (the APA administration reported that there were some challenges with contracting with a hotel for the 2020 meeting), and the Board felt that suspending the meeting for one year would give APA additional time to examine the feasibility of the meeting.Finally, APA leaders were asked to host a town hall meeting at APA’s 2019 Annual Meeting in San Francisco to further discuss the future of the IPS. Primary issues will include the value of a smaller meeting, opportunities to change the program format, and possible strategies for increasing the attendance of APA members as well as more of our partners in the public sector. The preliminary report presented to the Board last month indicated that approximately 50 percent of IPS attendees also attend the Annual Meeting, so we’re hoping that members who value the IPS will come to the town hall.It is important that we continue to have high expectations for this meeting, and it is equally important that we establish realistic approaches to meeting both our fiduciary and professional-development responsibilities. Losing sight of either could change the course of our profession in ways that impact our service, training, and research goals for generations to come. As always, we look forward to hearing what you think! More information on the town hall will appear in a future issue of Psychiatric News. ■ ISSUES NewArchived

Prisoner Participation in Psychiatric-related Research: Perceptions of Coercion and Exploitation

Introduction Worldwide, over 10.2 million people are incarcerated. In Europe and the United States, prisoners experience higher rates of psychiatric illness than the general population. Clinical research may help improve the range and quality of psychiatric services in prison. Yet given the history of research abuses against prisoners, and ongoing concern that prisoners may be coerced or exploited by researchers, U.S. and European regulations greatly restrict prisoner research. Scant data exists on whether prisoners view modern clinical research as coercive or exploitative. Aim/Objective To improve our understanding of how prisoners view their participation in psychiatric-related clinical research, we sought to identify whether prisoners perceive their research participation as coercive or exploitative. Methods 70 participants from six psychiatric-related clinical research studies in the U.S. were recruited and asked to rate their agreement with several statements regarding study participation. Results No prisoner felt threatened by someone to enroll, and only 1 felt pressured by someone to enroll. One felt taken advantage of by the study, and 2 felt exploited by the study. All but 1 agreed that prisoners should have more access to research in general. Conclusions On balance, prisoners from this group do not perceive their study participation as coerced or exploitative and desire greater research opportunities. Given the urgent need for research studies that can address the complex psychiatric problems prisoners face, a better understanding of prisoner views toward research elsewhere in the U.S. and Europe is needed. Such work could support the easing of restrictions on prisoner research.

What’s Wrong With the Poor?: Psychiatry, Race, and the War on Povertyby Raz Mical. Chapel Hill, N.C., University of North Carolina Press, 2013, 264 pp., $39.95.

What’s Wrong With the Poor?: Psychiatry, Race, and the War on Povertyby Raz Mical. Chapel Hill, N.C., University of North Carolina Press, 2013, 264 pp., $39.95.

ECP02-04 - Implications for training. Relevance of transcultural psychiatry for European early career psychiatrists and trainees

During the last decades, the field of psychiatry has grown tremendously, but despite prevailing optimism we are faced with many challenges. A major challenge is that psychiatric services in many European countries are faced with increasing immigrant populations. Here there is a need to integrate knowledge hereof in the undergraduate, graduate and postgraduate training curriculum.A main educational goal is to construct the core elements of a graduate training curriculum in psychiatry regarding cultural aspects to ensure high quality of psychiatric services via the creation of competent psychiatrists in all areas of Europe and promote the standard of training for cultural psychiatry by providing recommendations for training agreed upon by all stakeholders.No explicit health policy has been formulated in many countries with respect to immigrants of which a large proportion has a traumatized background with a variety of problems linked to this.Till now, the psychiatric curriculum in most areas comprises little training on cultural issues. On both under- and post-graduate level, the curriculum should comprise training in transcultural aspects of psychiatry.With increased globalization there is a need to pay more attention to cultural aspects at all levels and develop strategies to increase the cultural competence of mental health professionals.Consensus statements on psychiatric training and related issues related to cultural issues should be produced.The paper will discuss the content of a culture sensitive curriculum and strategies to implement it.

Policy, Structural Change and Quality of Psychiatric Services in Australia: The Views of Psychiatrists

Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services. A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire. Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased. According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system.

Policy, structural change and quality of psychiatric services in Australia: the views of psychiatrists

Objective: Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services. Methods: A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire. Results: Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased. Conclusions: According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system.

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Impact of Reimbursement Systems on Child Psychiatrists: A Comparison of Canada and the United States

This study measured satisfaction of US and Canadian child psychiatrists with quality of care in their field and behaviors of their payers. US and Canadian child psychiatrists were surveyed concerning time spent on billing paperwork, waiting times for psychiatrist reimbursement and patient treatment, and their satisfaction with psychiatric services and behaviors of payers. Initial and two nonresponder follow-up mailings of the survey were sent in 1992 to all 83 Canadian members of the American Academy of Child and Adolescent Psychiatry and a random sample of 212 US members. Canadians were significantly more satisfied than Americans with the quality and affordability of services for both inpatients and outpatients. Canadians were less likely to think that third-party payers were annoying or affected their clinical decision-making. Canadians spent less time on billing-related paperwork and received payment more promptly. Canadians, however, reported significantly longer waits for both inpatients and mildly ill outpatients, but not for severely ill outpatients. Canadian child psychiatrists were significantly more satisfied with the quality of psychiatric services and the behaviors of their payers, but Canadian patients experienced longer waits.