Regional Mental Health Service Research Articles

A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival

ObjectivesTo assess the stage at cancer diagnosis and survival after cancer diagnosis among people served by secondary mental health services, compared with other local people.SettingUsing the anonymised linkage between a...

Utilization of a cardiometabolic health nurse - a novel strategy to manage comorbid physical and mental illness.

BackgroundComorbid chronic illnesses, such as cardiovascular disease, respiratory conditions, and type 2 diabetes are common among people with serious mental illness. Management of comorbid illness in the mental health setting is sometimes ad hoc and poorly delivered. Use of a cardiometabolic health nurse (CHN) is proposed as one strategy to improve the delivery of physical health care to this vulnerable population.ObjectiveTo report the CHN’s utilization of primary care and allied health referrals from a trial carried out in a regional community mental health service.DesignFeasibility study. Mental health consumers were referred by their case manager or mental health nurse to the CHN. The CHN coordinated the physical health care of community-based mental health consumers by identifying the need for, and providing referrals to, additional services, including primary care, allied health, and community-based services.ResultsSixty-two percent of participants referred to the CHN received referrals for primary care, allied health, and community-based services. Almost all referrals received follow-up by the CHN. Referrals were most commonly directed to a general practitioner and for nurse-delivered services.ConclusionThe CHN role shows promise in coordinating the physical health of community-based mental health consumers. More studies on role integration and development of specific outcome measurement tools are needed.Journal of Comorbidity 2014;4:22–28

Оценка эффективности судебно-психиатрической профилактики

We discuss the quantitative indicators, the analysis of which gives an idea of the strengths and means at the disposal of forensic health care. We discuss the possibility of using the existing statistical monitoring system for a dynamic assessment of the quality of the measures for primary prevention of socially dangerous acts and implementation of compulsory medical measures at the regional and federal levels. We emphasize the quality indicators of the process for specialized assistance: security environment, organizational culture, training and upgrading the skills of staff, completeness and quality of psychosocial interventions, the degree of profiling the psycho-educational work, the quality of psychotherapeutic contact and its dynamics. We discuss the problem of the validity of the criteria of rehabilitation interventions success by compliance with the methodological principles for the evaluation of their effectiveness. We suggest ways to improve the effectiveness of regional mental health services for the prevention of socially dangerous acts, approaches to peer review and monitoring of the work.

The Koorie Men’s Health Day: an innovative model for early detection of mental illness among rural Aboriginal men

To describe the design, implementation and outcomes of an innovative model for the early detection of mental illness among rural Aboriginal men. Through a collaborative effort between a University' Department of Rural and Indigenous Health, an Aboriginal organisation and a regional mental health service, an all-male team was set up which consisted of a doctor, a mental health nurse and four key individuals from the local Aboriginal community. Invitations to attend a Koorie Men's Health Day were distributed via flyers and posters. Using an assembly line technique and avoiding any reference to the term 'mental', all participants underwent a complete medical examination, a blood test for diabetes and a psychological assessment using the Kessler-10 schedule. The event was attended by 20 men. Of the 17 participants whose data were available, seven scored significantly (25 or higher) on the psychological assessment and were offered follow-up. When conducted on a regular basis, the Koorie Men's Health Day could be a useful method for the early detection of mental illness among rural Aboriginal men in Australia. Further research is needed to study the feasibility and sustainability of the model in different settings.

To what extent could acute general psychiatric day care reduce inpatient admissions?

Background: Percentage reduction of inpatient admissions by acute general psychiatric day care in individual facilities (i.e. feasibility rate of acute day care) seems to be an important parameter for service planning. Previously reported feasibility rates showed significant variation, however, and were based on eligibility criteria defined for randomized controlled trials. This paper aims to perform an in-depth exploration of the calculation method of these feasibility rates, to propose different calculation methods expanding research definitions to the reality of service provision, and to analyze the association between the availability of residential services in regional mental health service systems and these rates. Methods: Data from the randomization process of the European Day Hospital Evaluation (EDEN) study in which a total of 1117 patients were included in five sites provided the basis to calculate site-specific and overall rates of patients for whom this mode of treatment might be adequate. Sensitivity analyses were carried out by varying the selection of patients’ eligibility criteria and thus calculating different feasibility estimates. Data on the regional mental health care systems were collected by use of the European Service Mapping Schedule. Results: The use of four different calculation methods showed that site-specific feasibility rates of acute day care for general psychiatric patients varied from 13.8% to 25.7% up to 44.1% to 79.0%. Overall rates varied from 17.3% up to 67.7%, respectively. The high values were calculated under a scenario where the current acute day care model of care is enhanced to manage more complicated patients than currently treated under existing acute day care models. In three out of the four calculation methods higher rates were calculated for sites which demonstrated higher figures of residential services, and thus were less advanced in their process of deinstitutionalization. Conclusions: In order to determine the capacity of day hospitals as an alternative to acute psychiatric hospital care, mental health care planning must clearly decide on the eligibility criteria of patients to be treated in these facilities. Guided by such definitions, treatment concepts and professional qualifications of the staff in these facilities need to be adapted. The finding that less de-institutionalized regions may benefit most from a transition to acute day care as a means for promoting the transition to a community model of care for otherwise institutionalized patients must be assessed in more detail. Comprehensive research exploring the impact of all regional mental health service configuration characteristics on the concept of acute day care is needed.

E-CYMHS: an expansion of a child and youth telepsychiatry model in Queensland

The purpose of this study was to describe the evolution of the E-Child and Youth Mental Health Service (E-CYMHS), which supports regional and rural mental health services by providing access to consultant child and adolescent psychiatrists to isolated staff in regional areas, where access to specialist psychiatric services is limited. E-CYMHS provides a level of parity in mental health care between metropolitan, regional and remote services through the provision of regular videoconferencing services with child and adolescent psychiatrists and senior allied health clinicians. The three key features which underpin the success of the service are: 1. A central co-ordinator of services; 2. Provision of support outside regular videoconference times; and 3. Routine outreach visits that foster community capacity-building. E-CYMHS has been well received by the regional mental health services it supports, and the total provision of services has more than doubled over the last three years. It is anticipated that as telepsychiatry is increasingly viewed as a credible alternative to traditional means of patient care, this trend is likely to continue.

Determining mental health research priorities in a Queensland region: An inclusive and iterative approach with mental health service clinicians, consumers and carers

Australia has national and state mental health plans that guide service development and promote quality in its public mental health system. Interestingly though, Australia still lacks a well-managed, priority-driven program of research in the mental health sector. This lack is perhaps indicative of the historical relative lack of funding for mental health research compared with other areas of health, at a national level. As a result, approaches to research tend to be ad hoc and reactive to emergent problems. In 2009–2010, a participatory action research study using elements of the consensus oriented Delphi method was implemented in a Queensland regional public mental health service. The aims of the study were to identify and prioritise research questions of importance to the local public mental health service and its members, to compare local priorities with national and state research agendas, and to identify needs relating to research capacity. Data were collected using a modified Delphi technique, three rounds of surveys, field notes and research team reflection.The study reached consensus, with all three cohorts of participants agreed that emotional well-being was the most important research area. The second most important research area was service quality and accountability. The equal third most important research areas were family involvement in the care of their relative and personal (that is, consumer) involvement in their own care.

Mental health services for Aboriginal men: Mismatches and solutions

This paper describes the perceptions of Aboriginal stakeholders as well as mental health personnel on improving Aboriginal men's access to mental health services. From January 2009 to June 2010, 23 semi-structured interviews and three focus groups were conducted with 17 Aboriginal stakeholders and 29 mental health staff from a regional mental health service in Victoria. A qualitative description design was adopted and data were analysed thematically. Seven themes emerged from the data. Three themes focused on the mismatch between mainstream mental health service provision and the mental health needs of Aboriginal men. They include barriers to gaining entry into services, barriers to engagement with services, and staffing problems in the services. The remaining four themes related to possible solutions to improving men's access to services and included building men's confidence in services, developing relationships with the Aboriginal Community, enhancing flexibility of services, and strengthening the role of the Koori Mental Health Liaison Officer. The dual perspectives of Aboriginal stakeholders and service providers provide a more comprehensive picture of the ground realities concerning Aboriginal men's access to mental health services. The findings have implications for the provision of culturally sensitive mental health services for Aboriginal men.

Patterns of mental health service contact before and after forensic mental health contact in New Zealand

To describe patterns of mental health service contact before and after contact with a regional forensic mental health service (FMHS) to assist regional mental health service planning. All new referrals to Auckland Regional FMHS in 2006 were audited for contact with mental health services in the three years before and three years after their contact in 2006. A total of 925 identified individuals were referred to the Auckland Regional FMHS in 2006, predominantly through the court (81%) or prison (17%). In the preceding three years, 30.2% of these service users had no mental health service contact, 41.4% had general adult mental health service (GAMHS) contact alone, 22.6% had both FMHS and GAMHS contact, and 5.8% had FMHS contact alone. In the three years after 2006, 13.4% had no further contact with either FMHS or GAMHS, 20.3% had GAMHS contact alone, 51.2% of the sample had contact with both FMHS and GAMHS, and 15% had only FMHS contact. The service utilization patterns of this population support the establishment of strong links between GAMHS and FMHS in courts and prisons. Further research is needed to determine the specific models most likely to improve clinical outcomes.

Determining mental health research priorities in a Queensland region: An inclusive and iterative approach with mental health service clinicians, consumers and carers

Australia has national and state mental health plans that guide service development and promote quality in its public mental health system. Interestingly though, Australia still lacks a well-managed, priority-driven program of research in the mental health sector. This lack is perhaps indicative of the historical relative lack of funding for mental health research compared with other areas of health, at a national level. As a result, approaches to research tend to be ad hoc and reactive to emergent problems. In 2009–2010, a participatory action research study using elements of the consensus oriented Delphi method was implemented in a Queensland regional public mental health service. The aims of the study were to identify and prioritise research questions of importance to the local public mental health service and its members, to compare local priorities with national and state research agendas, and to identify needs relating to research capacity. Data were collected using a modified Delphi technique, three rounds of surveys, field notes and research team reflection.The study reached consensus, with all three cohorts of participants agreed that emotional well-being was the most important research area. The second most important research area was service quality and accountability. The equal third most important research areas were family involvement in the care of their relative and personal (that is, consumer) involvement in their own care.

Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service

This audit reviewed current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. A sample of 60 case files, care plans and prescriptions were audited, which is 31% of the total number of service users receiving depot injections in the mental health service region (n= 181). The sample audited had a range of diagnoses, including: schizophrenia, schizoaffective disorder, bipolar affective disorder, depression, alcoholic hallucinosis and autism. The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only five (8%) case notes examined had documentation recorded describing the condition of the injection site, and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded. In 57 (95%) of case notes, no documentation of recorded information on the depot and on side effects was given. The failure to monitor and record some blood tests was partly attributed to a lack of clarity regarding whose responsibility it was. A standardized checklist has been developed as a result of the audit and this will be introduced by all teams across the service.

Depressive Disorders among Adolescents Managed in a Child and Adolescent Mental Health Service

The aims were to describe the prevalence and treatment of depressive disorders among case-managed adolescents attending a regional Child and Adolescent Mental Health Service (CAMHS). An observational study was conducted in a regional CAMHS over a 3-month period. Clinicians recorded treatment of their case-managed adolescents aged 12-18 years at the end of each calendar month. The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) and Children's Global Assessment Scale (CGAS) were collected at the beginning of the study period or at entry into the service, and repeated at discharge from the service or at the conclusion of the study period. Adolescents also completed the Reynold's Adolescent Depression Scale, 2nd edition. Depressive disorders were the most common clinician diagnosis reported (22%). There was no statistically significant difference in treatment for depressed compared to non-depressed adolescents. There was a statistically significant improvement in both the HoNOSCA scores (p <0.001) and CGAS scores (p <0.001) for the whole sample. Treatment appeared to be the same in type for depressed compared to non-depressed adolescents case managed within CAMHS.

Mental health consumers' perceptions of receiving recovery‐focused services

This study examines the experiences of mental health service consumers engaged in various recovery-focused support practices as well as examining consumer valuing of these activities. A self-report questionnaire was developed drawing on key aspects of the Collaborative Recovery Model (CRM) (responsibility, collaboration, autonomy, motivation, needs, goals, homework). Ninety-two adult consumers from metropolitan, regional and rural non-government organizations and public mental health services in eastern Australian states completed the questionnaire. Consumers using services provided by CRM-trained workers identified significant changes to service delivery in relation to frequency with which they were encouraged to take responsibility for their recovery, degree to which they collaborated with staff and the extent to which they were encouraged to complete homework activities to assist them to achieve their goals, when compared with consumers using traditional services. The key aspects of the CRM were valued by consumers. No differences were found in terms of overall ratings of clinician helpfulness in assisting recovery between the two groups. Consumers are able to perceive recovery-focused service changes. Although preliminary, this is a significant step towards assessing the operationalization of recovery principles from the consumer's perspective.

P02-96 Evidence supporting the historical context for current views on unmet need in child and adolescent mental health

Objective:In over 60 years little has changed in children's mental health and the flag waving continues: It is time for action in the trenches. It is imperative to focus health policy on the need to provide basic mental health succor to children and their families. A failure to alter the situation related to children's mental health will no doubt have catastrophic consequences for our society. We review the level of progress made in reforming regional mental health services since 2002.Methods:Using population-based representation of regional service utilization capacity permits comparison of regional, provincial and national rates of child and adolescent mental disorder.Results:Regional services in the last 6 years have served at most approximately 1% of the 0-18 year old population annually. This rate represents an increase from about 0.6% in 2002.Conclusions:Rationing the scant professional resources that exist to serve children's mental health will become increasingly difficult. For example, it is estimated that three percent of 0-18 year-olds are estimated to suffer a debilitating mental problem. Implication for policy are that our results point to service gaps in need of immediate policy development to meet basic needs of children. Several strategies are considered.

PW08-05 Evidence supporting the historical context for current views on unmet need in child and adolescent mental health

Objective:In over 60 years little has changed in children's mental health and the flag waving continues: It is time for action in the trenches. It is imperative to focus health policy on the need to provide basic mental health succor to children and their families. A failure to alter the situation related to children's mental health will no doubt have catastrophic consequences for our society. We review the level of progress made in reforming regional mental health services since 2002.Methods:Using population-based representation of regional service utilization capacity permits comparison of regional, provincial and national rates of child and adolescent mental disorder.Results:Regional services in the last 6 years have served at most approximately 1% of the 0-18 year old population annually. This rate represents an increase from about 0.6% in 2002.Conclusions:Rationing the scant professional resources that exist to serve children's mental health will become increasingly difficult. For example, it is estimated that three percent of 0-18 year-olds are estimated to suffer a debilitating mental problem. Implication for policy are that our results point to service gaps in need of immediate policy development to meet basic needs of children. Several strategies are considered.

Health outcomes for people with serious mental illness: a case study.

To describe outcomes of clients with serious mental illnesses who used regional public mental health services; and what the public mental health system did well or needed to change to better satisfy clients' needs. A modal case study analysis method was used with 15 clients. Participants were interviewed three times. Participants reported dissatisfaction with their social functioning and general health, and unmet needs for case management services, social/recreational activities, and vocational rehabilitation. The case study method is an effective way for nurses to evaluate public mental health systems and to determine areas for system intervention.

Overcoming Barriers in Referral from Schools to Mental Health Services

This survey of primary, secondary and area schools investigated their referrer satisfaction with six Child and Adolescent Mental Health Service (CAMHS) teams, spread over two metropolitan and four rural centres, and servicing six corresponding metropolitan and rural education districts. The survey aimed to identify barriers to referral from schools to CAMHS and to generate domains for quality improvement across the six local areas. School principals and counsellors completed the online Southern Schools Satisfaction Survey, which sought qualitative comment about aspects of the community mental health service in their area. The response rate (65%) was reasonably good for a large online survey, with 149 schools participating (171 respondents: 113 principals and 58 counsellors). The majority of the respondents were satisfied with the service from CAMHS (24% were 'very satisfied', 47% 'mostly satisfied' 23% 'mildly dissatisfied' and 6% 'very dissatisfied'). The main barriers and sources of dissatisfaction that schools identified were CAMHS waiting lists, service availability and lack of flexibility. Practices from the team with the highest percentage of satisfied school respondents formed a constructive basis for service-wide quality improvement. These changes focused on flexibility in emergency responses, communication with schools and process of care with students. Surveying referrer satisfaction can be useful for quality improvement within regional mental health services through the identification of good practice which can be transferred across teams.

Collective inquiry: understanding the essence of best practice construction in mental health

Delivering quality services has become a committed aspiration of mental health services over the past decade. Service planners look to validated care models to give guidance on what constitutes best practice. While there are many different views of what is 'best', there is a growing acknowledgement that services need to listen to the experiences of a network of frontline stakeholders in order to create quality mental health services. This paper describes an exploratory study within a regional mental health service that aimed to understand the meaning and enactment of best practice from the perspectives of a representative sample of service users and providers. A number of themes emerged as important and include the inherent value placed on consistent familial style relationships between service user and provider. This was deemed pivotal to the provision of expertise, good clinical decision-making, choice and collaboration. The study also highlighted stakeholder preference for autonomy and openness to inquiry into developing practice. In deconstructing the meaning of best practice, the study prompts a closer consideration of how best practice is created and suggests a view of best practice as a fluid dialogic process that is co-constructed by its participants in ongoing dialogic communication and reflection.

A Basic Criterion for Transformation

Back to table of contents Next article Taking IssueFull AccessA Basic Criterion for TransformationLarry Davidson Ph.D.,Larry Davidson Ph.D.Search for more papers by this author,Published Online:1 Aug 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As systems of care take up the challenge of transformation, various perspectives will arise on the desired outcomes of this process. Systems enter the process at different points, with different resources, and with different ideas of what they seek to achieve. This diversity can be useful, as homegrown strategies can be tested, successful approaches shared, and solutions tailored to ever-changing conditions.I am concerned, however, that systems have already begun labeling as "recovery oriented" some services they have been providing for the past 30 years and have introduced as "transformative" new programs that leave much of the existing system intact. This concern is reinforced by the report in this issue by Rogers and colleagues, in which psychiatrists viewed the implications of recovery as limited to increased funding for rehabilitation, not appreciating how all mental health care, including their own practice, needs to be reoriented toward recovery. Such limited changes fall well short of the "fundamental refashioning" called for by the President's New Freedom Commission and risk repackaging old wine in new bottles. To avoid this temptation, perhaps we could achieve a consensus on the bare minimum we need to accomplish before transformation can be said to have occurred. I would like to propose one such minimum criterion.The "promise" we have yet to achieve, to which the title of the New Freedom Commission report refers, was the promise first made a half century ago, that people with mental illnesses would be able to live "in the community in a normal manner." Given that the New Freedom Commission's vision is likewise "a life in the community for everyone," I propose that people do not have a life in the community as long as, and to the degree to which, they remain hospitalized. Having a life in the community should not equate with residing in an institution. Hospitals serve an important function in recovery-oriented systems of care, offering acute care for acute episodes. Since the Olmstead decision, however, hospitals can no longer be considered acceptable places to live. Systems that invest scarce resources in training inpatient staff in person-centered planning, hoping to transform care by offering patients choices of meal times, neglect the fact that most people confined to hospitals would choose to live in the community. Such individuals, who still number in the tens of thousands, need safe, affordable housing options with responsive supports. Although transformation can involve more than this, it should not involve less. As the commission report makes clear, we now know how to afford people a life in the community. Achieving this promise is where and when true transformation will begin. Department of Psychiatry, Yale University FiguresReferencesCited byDetailsCited ByThe meaning of recovery in a regional mental health service: an action research study5 July 2014 | Journal of Advanced Nursing, Vol. 71, No. 1From experience to action in recovery-oriented mental health practice: A first person inquiry26 May 2014 | Action Research, Vol. 12, No. 4Not Just an Individual Journey: Social Aspects of Recovery15 October 2009 | International Journal of Social Psychiatry, Vol. 57, No. 1 Volume 58Issue 8 August, 2007Pages 1029-1029PSYCHIATRIC SERVICES August 2007 Volume 58 Number 8 Metrics PDF download History Published online 1 August 2007 Published in print 1 August 2007

Consumer advocate and clinician perceptions of consumer participation in two rural mental health services

Consumer participation has been heralded as the integration of consumer perspectives into standard mental health care. Using a qualitative descriptive method, this study had two broad aims. First, the study aimed to explore the perceptions of consumer advocates and clinicians regarding consumer participation in two new regional mental health services. Second, the study aimed to explore how broad policy initiatives, related to consumer participation, are enacted at a service delivery level. In-depth interviews were conducted with 10 participants, recruited from the steering committees of both services. Although all participants uniformly commended consumer participation as a reality in mental health services, its breadth and depth of influence was not enacted. A systemic change to the way consumer participation is funded and incorporated into mental health services is required. The incorporation of consumers as stakeholders within mental health services requires commitment to the idea, the establishment of clear purposes and roles, and commensurate funding to enable consumers to be stakeholders with similar resources to other stakeholder groups.