Services In Ireland Research Articles

Unique perspectives from the transgender community: A retrospective chart review of cancer care needs for transgender patients.

6566 Background: It is estimated that 1% of a population experience some degree of gender non-conformity. There is scant information worldwide on cancer incidence and mortality for this population however due to a lack of investigating large-scale prospective studies. National cancer registries do not hold demographics on this population. Current literature indicates transgender people may face an increased cancer risk. Transgender patients may avoid screening programmes for cancers which are themselves gendered. Transgender patients can feel excluded from gender specific cancer support groups. We set out to identify how cancer services in Ireland can better meet transgender people’s unique needs. Methods: Medical oncology consultants in the South/South-West of Ireland were contacted to identify patients who identified as transgender or gender non-conforming. We carried out a retrospective chart review of the four transgender patients identified. We analysed staging at diagnosis, family supports, smoking history, alcohol use and whether cancer treatment affected gender transitioning treatment and if this had documented effects on mental well-being. We also noted if medical records reflected a new name or change of gender and if not, whether original name and gender used for chemotherapy and blood product administration. Results: All four patients were diagnosed with relatively advanced disease at diagnosis- Stage IIIc high grade ovarian cancer, stage IV gastrointestinal tumour, stage IVb diffuse large B Cell and locally advanced extra-abdominal desmoid tumour. Of the four patients, three had a smoking and alcohol history on diagnosis. All four patient’s recent medical correspondence reflected a name and gender change but the medical records did not reflect this. Three patients had documented depression for which they were attending psychiatry services. It was noted that two patients had gender transitioning treatment postponed due to cancer care. Minimal family support was noted for two patients. Conclusions: The transgender community is a growing population that will continue to integrate into mainstream society. Our retrospective chart review adds to a growing body of evidence which suggests gender minorities may suffer from cancer-related disparities and have an increased need for psychosocial support. As in other studies, it is difficult to identify these individuals. We should identify gender minority individuals and report this data in medical records in order to build much needed epidemiological information.

Hanafy Ahmed Mahmoud Youssef

Hanafy Ahmed Mahmoud Youssef was a strong advocate for community based psychiatry. He set up the first community based service in Ireland. He was able to show that this led...

Hypermobility, developmental coordination disorder and physical activity in an Irish paediatric population.

The primary aim of the study was to explore the prevalence of generalized joint hypermobility (GJH) and generalized hypermobility spectrum disorder (gHSD) using the new classification system in a community paediatric physiotherapy service in Ireland. The second aim was to explore the relationship between GJH, gHSD and physical activity level, while considering the association of probable developmental coordination disorder (pDCD). A case-controlled cross-sectional study of children aged 6-12 years, recruited from the community paediatric physiotherapy department (n = 32) and a local school (n = 41), was carried out. A Beighton score of ≥6/9 distinguished GJH. The new framework for hypermobility spectrum disorder (HSD) was used. Self-reported physical activity level was measured using the Physical Activity Questionnaire-Older Children. A parent-reported validated questionnaire screened for pDCD. The prevalence of GJH was 21.9% of children attending physiotherapy. One child in the physiotherapy group was identified as having gHSD, with a prevalence of 3.1%. There was no significant difference in physical activity level between children with and without GJH attending physiotherapy (independent samples t-test, p = 0.28). Probable developmental coordination disorder (pDCD) was observed in 71.9% of children attending physiotherapy. There was no significant difference in the number of children with pDCD in those with and without GJH (Fisher's exact test, p = 0.370). This study was the first to explore the prevalence of GJH and gHSD in the paediatric physiotherapy population in Ireland. The presence of GJH did not affect self-reported physical activity level or motor coordination in children attending physiotherapy.

Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service.

Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM. To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores. Data from outpatient clinics were collected at each contact over 2years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores. A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20-F29 (Schizophrenia, schizotypal and delusional disorders) F30-F39 (mood disorders) F40-F48 (neurotic, stress-related and somatoform disorders) and F50-F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = - 0.919, p < 0.001). This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient’s symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

Monogenic causes of chronic kidney disease in adults

Approximately 500 monogenic causes of chronic kidney disease (CKD) have been identified, mainly in pediatric populations. The frequency of monogenic causes among adults with CKD has been less extensively studied. To determine the likelihood of detecting monogenic causes of CKD in adults presenting to nephrology services in Ireland, we conducted whole exome sequencing (WES) in a multi-centre cohort of 114 families including 138 affected individuals with CKD. Affected adults were recruited from 78 families with a positive family history, 16 families with extra-renal features, and 20 families with neither a family history nor extra-renal features. We detected a pathogenic mutation in a known CKD gene in 42 of 114 families (37%). A monogenic cause was identified in 36% of affected families with a positive family history of CKD, 69% of those with extra-renal features, and only 15% of those without a family history or extra-renal features. There was no difference in the rate of genetic diagnosis in individuals with childhood versus adult onset CKD. Among the 42 families in whom a monogenic cause was identified, WES confirmed the clinical diagnosis in 17 (40%), corrected the clinical diagnosis in 9 (22%), and established a diagnosis for the first time in 16 families referred with CKD of unknown etiology (38%). In this multi-centre study of adults with CKD, a molecular genetic diagnosis was established in over one-third of families. In the evolving era of precision medicine, WES may be an important tool to identify the cause of CKD in adults.

Implementing co-production in traditional statutory mental health services

Since the publication by the Department of Health and Children in 2006 of A Vision for Change, which sets out the direction for mental health services in Ireland, new approaches to interacting with people who have lived experience of mental ill health have emerged. Co-production is one such approach. Co-production is a word used to describe the creation of a dialogical space where the service user, family members, carers and service providers enter a collaborative medical partnership to improve their own care and also service provision. Co-production is a cornerstone in the delivery of a recovery-oriented service and when implemented correctly it has the power to achieve positive change.The aim of this article is to provide background information and guidance on how to implement co-production in traditional mental health services. It is in line with the publication and implementation of the Irish recovery guidance document, A National Framework for Recovery in Mental Health, by the Health Service Executive in 2017.

Changes in the Provision of Day Services in Ireland to Adult Persons With Intellectual Disability

AbstractInternationally, changes are advocated in the support available to persons with intellectual disability. Socially inclusive personalized arrangements are intended to replace congregated and segregated day services. The study examines the changes in the provision of day services within Ireland over a 5‐year period when new policies were being promoted but at time of economic stringencies. Secondary analysis was carried out on data extracted from the National Intellectual Disability Database on all persons aged 18 years and above in 2009 and 2014 who received day services, which were grouped into four main types: care centers, sheltered workshops, employment schemes, and vocational training. Participants in each type of service were profiled by age, level of disability, and living arrangements. Variations in the provision of these services across nine regions were also examined. In 2009, 59% of persons attended care centers, but the proportion had increased in 2014 to 69%. There were reductions in the numbers attending sheltered workshops (down from 23 to 16%) and those receiving employment supports (down from 13 to 11%). By 2014, variations in the numbers attending care centers were evident across the country. The increase in care provision does not accord with national or international policies. Rather, it may reflect ineffective policy implementation strategies and financial cutbacks which services experienced during this period. This study illustrates the value of a national dataset for monitoring policy implementation.

Is the Irish (Republic of) Comprehensive Employment Strategy Fit for Purpose in Promoting the Employment of People with Intellectual Disabilities in the Open Labor Market? A Discussion Using Evidence from the National Intellectual Disability Database

AbstractPeople with intellectual disabilities are largely absent from the labor market. Instead many people with intellectual disabilities attend one or more of the various employment, day, work (occupational) and training services available. This paper considers the impact of adult day service reform along with the new comprehensive employment strategy (CES) might have in improving the participation of people with intellectual disabilities in the open labor market. Day and employment services for people with intellectual disabilities in Ireland are largely organized though the Health Service Executive (HSE), the medical arm of Ireland's service machinery. However, these services have kept Irelands “invisible citizens” segregated, and separate from their communities. Despite identifying this problematic issue, services intended to support people with intellectual disabilities to lead more meaningful and fulfilled lives and be included in their communities have been unsuccessful in achieving this. Although successive governments and have announced to phase out segregated service provision for people with intellectual disabilities so that they can lead integrated lives as part of their communities, trends in the data reveal a growth rather than a decline in specialist, segregated service attendance. The widespread closures of employment services that operated as sheltered workshops, for example, did not lead to an automatic increase in the employment rates as would perhaps be expected. This signals that, despite the promise of better community inclusion through revived policies, as part of the mainstreaming agenda, services still largely operate in separate spheres and people with disabilities continue to lead marginalized lives on the peripheries of society. This research concludes that current disability policies in place to improve the lives of persons with disabilities and increase their participation and inclusion have had limited success. Most people with intellectual disabilities continue to attend adult days services rather than participating in their communities or engaging in meaningful work.

An investigation of the effect of accessibility to General Practitioner services on healthcare utilisation among older people

Equity in access to healthcare services is regarded as an important policy goal in the organisation of modern healthcare systems. Physical accessibility to healthcare services is recognised as a key component of access. Older people are more frequent and intensive users of healthcare, but reduced mobility and poorer access to transport may negatively influence patterns of utilisation. We investigate the extent to which supply-side factors in primary healthcare are associated with utilisation of General Practitioner (GP) services for over 50s in Ireland. We explore the effect of network distance on GP visits, and two novel access variables: an estimate of the number of addresses the nearest GP serves, and the number of providers within walking distance of a person's home. The results indicate that geographic accessibility to GP services does not in general explain differences in the utilisation of GP services in Ireland. However, we find that the effect of the number of GPs is significant for those who can exercise choice in selecting a GP, i.e., those without public health insurance. For these individuals, the number of GPs within walking distance exerts a positive and significant effect on the utilisation of GP services.

Voter participation among people attending mental health services in Ireland

People with mental illness experience social and political exclusion but there is limited understanding of voting behaviour in this population. This study assessed voter participation and attitudes towards voting among people attending mental health services in Dublin, Ireland. Psychiatry outpatients and inpatients were studied over2months following Ireland's 2016 general election (n = 117). Characteristics of participants who did and did not vote were compared and reasons for voting choices explored. Over half of participants (52.1%) voted (national rate 65.1%) although more (83.8%) were registered. Forty-one percent had insufficient information about voting: the most common information deficits related to voting rights (31.6%) and voting in hospital (18.8%). Inpatients (20.0%) were substantially less likely to vote than outpatients (63.2%). Majorities endorsed the importance of people with mental illness voting. The most common reasons for not voting were being in hospital (32.1%) and not being registered (30.4%). Politicians should note that a majority of people with mental illness are outpatients and a significant proportion vote. Voting among inpatients has improved since 2011 but more information and support are needed to optimise voting rates in this population.

Developing citizen advocacy for adults with intellectual disability

In 2010, the Report of Disability Policy Review Keogh 2010 was prepared on behalf of the Expert Reference Group on Disability Policy and its findings contributed to the subsequent Value for Money and Policy Review of Disability Service in Ireland Report DoH 2012, which evaluated the efficiency and effectiveness of Health Service Executive HSE funded statutory and non-statutory disability services in Ireland. The Keogh 2010 report emphaisised the importance of advocacy in developing person centred care services. This imptus became more important as various media scandals highlighted some incidents of poor care to people with intellectual disability. In 2016, Sage Advocacy & Support for Older People were given funding to develop a citizen advocacy project for adults with itellectual disability in Ireland. This study presents the findings from engagement with adults with intellectual disability, their families and formal caregivers. This project sought to gain understanding and depth into the perspectives of people with intellectual disability on their life world and to generate other stakeholders’ perspectives regarding caring for this population. Consequently, the study used a qualitative approach, which enables deep and rich insights to people’s lives and experiences and is valuable in examining the interpersonal aspects of care important to patients. Specifically narrative inquiry has the potential to produce themes from the accounts of the study participants. Ethics approval was gained from University College Dublin. Participants were recruited from contacting the facilities who provided care to adults with intellectual disability. Nine focus groups 5 with service users and 4 with service providers were held as well as 4 semi structured interviews 4 with family members of the person and 2 with key stakeholders with intellectual disability and a survey with the Irish Association of Social Workers. Data were analysed using Braun & Clarke's thematic anlysis approach with the assistance fo NVIVO 10. Five themes were developed: Personhood, Service Challenges, Family experiences, Society’s approach to people with intellectual disability, The need for my voice to be heard. These themes enabled multiple perspectives to be considered, particualarly emphasing the need to priortise the will, preference, values and beliefs of people with intellectual disabiity and the need for service users and families to empower rather than be paternalistic. Limitations of the study will also be presented.

After the 8th: Ireland, Abortion, and International Law

By repealing the 8th amendment, the Irish people gave its government a strong mandate to liberalize its restrictive abortion laws. In this paper, we argue that international law has a significant role to play in the drafting, interpretation and monitoring of Ireland’s future proposed abortion law framework. We explore the relationship between international and domestic law, and argue that there are three key roles for international law in the current abortion context, namely: (1) ensuring at a minimum that new abortion laws are drafted in a way which respects Ireland’s international law obligations; (2) ensuring that laws are interpreted and implemented in a way which facilitates practical and effective access to abortion, and (3) providing avenues to challenge obstacles to securing legally available abortion services in Ireland. In making these arguments, we acknowledge that although Ireland is party to a variety of international law treaties which set out obligations in respect of abortion access, these obligations were conspicuously absent from the abortion debate in the lead up to the referendum. We argue that this stemmed from confusion around the extent of Ireland’s obligations in this context and the relationship between domestic and international law. In our view, international law’s lack of salience in the past is highly regrettable and we argue that it is vital that we do not repeat past mistakes. In short, engaging more closely with Ireland’s obligations in international law will play a key role in ensuring that the Irish government does not to waste this once in a generation opportunity.

Health system changes needed to support people consulting general practice out of hours services in Ireland

BackgroundMental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties.AimTo establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral.Design and settingDescriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc).MethodsAn anonymous extraction of retrospective data from 1 year of the out of hours’ electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care.ResultsOver a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend.ConclusionsThere are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.

Advanced Paramedic Delivered Finger Thoracostomy

&lt;p&gt;&lt;strong&gt;Introduction &amp;amp; Aims&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Tension pneumothorax is a potentially fatal but reversible injury encountered in major trauma and traumatic cardiac arrest. Needle decompression has been the standard treatment approach pre hospital in Ireland and internationally. However, concerns exist regarding the effectiveness of this approach due to anatomy and body habitus. We aim to describe the training, introduction and experience of finger thoracostomy by advanced paramedics within a pre hospital service in Ireland.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Finger thoracostomy has been advocated as an alternative pre hospital treatment which is both diagnostic and therapeutic. Paramedic delivered thoracostomy is commonplace in pre hospital critical care services internationally. The MCI Medical Team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team which provides medical cover at motorcycle road racing events in Ireland. The MCI Medical Team has significant experience of major trauma and routinely performs pre hospital anaesthesia for trauma patients. We introduced a training module on finger thoracostomy, comprising: theory, practical instruction and assessment for advanced paramedic members of the team.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results &amp;amp; Conclusions&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Advanced paramedic members of the team we trained to deliver finger thoracostomy in predefined circumstances when operating as part of the MCI medical team. To date, advanced paramedic delivered finger thoracostomy has been utilised on three occasions. Introduction of advanced paramedic delivered thoracostomy is a feasible and effective technique for the treatment of tension pneumothorax within a closely governed system.&lt;/p&gt;

Preparing The Critically Ill Adult Patient for Transfer

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;The reorganisation of hospital services in Ireland, the development of hospital groups, centralisation of specialties and reconfiguring of smaller hospitals necessitates inter hospital transfer of patients requiring specialist care to an appropriate hospital that meets their clinical needs. In Ireland, in excess of 1000 adult critical care inter hospital transfers occur per annum(1). The ‘hub-and-spoke’ model is aligned with the hospital group structure and connectivity between hospitals is provided through agreed transport and retrieval services. These transfers are generally undertaken by local teams (usually an anaesthetic NCHD and a nurse) using an emergency ambulance and crew. Multidisciplinary team training is provided, by Critical Care Retrieval Services, using local resources in a framework enhancing safety and preparedness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;A critical care transfer checklist with a systematic approach provides a framework to address the elements of critical care, transport physiology changes and reduce potential adverse events when transferring critically ill patients (2). The use of transport specific adjuncts and packaging the patient systematically not only addresses transport issues e.g. temperature, but also facilitates emergency interventions en route.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Patient safety is a fundamental principle in healthcare and is the responsibility of healthcare practitioners to apply quality improvement methods to effect process and system improvements. The use of a systematic approach to patient management when transporting critically ill patients establishes a higher level of performance reduces cognitive dissonance and provides a framework for clinical teams and reduces the potential for human error (3).&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Clinical handover practices among healthcare practitioners in acute care services: A qualitative study.

To examine clinical handover practices in acute care services in Ireland. Objectives were to examine clinical handover practices between and within teams and between shifts, to identify resources and supports to enhance handover effectiveness and to identify barriers and facilitators of effective handover. Clinical handover is a high-risk activity, and ineffective handover practice constitutes a risk to patient safety. Evidence suggests that handover effectiveness is achieved through staff training and standardised handover protocols. The study design was qualitative-descriptive using inductive analysis. The study involved a series of focus group discussions and interviews among a sample of healthcare practitioners recruited from 12 urban and regional acute hospitals in Ireland. A total of 116 healthcare professionals took part in 28 interviews and 13 focus group discussions. We analysed the data using the directed content analysis method. Data collection generated rich qualitative data, yielding five categories from which two broad themes emerged: "policy and practice" and "handover effectiveness." The themes and their associated categories indicate that there is limited organisational-level policy and limited explicit training in clinical handover, that medical and nursing handovers are separate activities with somewhat different purposes and different modes of execution, and that several factors in the acute care setting, including location, timing and documentation, act as either barriers or enablers to handover effectiveness. The evidence in the current study suggests that clinical handover merits increased level of prominence in hospital policies or operating procedures. Medical and nursing handover practices represent distinct activities in their content and execution that may be related to cultural and organisational factors. Achieving multidisciplinary team handover requires a change in embedded traditional practices. Several aspects of the clinical handover activities of nursing and medical staff appear to diverge from best-practice evidence.

A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh Postnatal Depression Scale (EPDS).

Ireland has the second-highest birth rate in Europe and poorly developed perinatal psychiatry services. There are no screening services for antenatal depression and no data available on prevalence rates of depression among women attending the Irish obstetric services. The aim of this study was to assess the prevalence rates of depression during pregnancy in a population sample in Ireland using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. Pregnant women during all stages of pregnancy were recruited from five maternity hospitals throughout the Republic of Ireland. Approximately 5000 EPDS questionnaires were collected. Information on the participant's age, gestational week, gravidity, parity, and level of education attained was also collected. A score of > 12 was used as a measure of probable depression. Overall, 15.8% of pregnant women scored > 12 in the EPDS. There was a significant association between gestational week and rates of depression, with increasing rates occurring with advancing pregnancy (p< 0.001). Overall, higher socioeconomic groups were over-represented in the sample although we replicated the well-established findings of higher EPDS scores in women with lower educational attainment (p< 0.005). This study demonstrates that prevalence rates of probable antenatal depression are high among women attending the obstetric services in Ireland and highlight the importance of increasing awareness of antenatal depression. These high rates of antenatal depression may be related to certain conditions that are specific to an Irish setting: the absence of screening for depression in the context of grossly under-resourced perinatal psychiatry services. These findings provide indirect confirmatory evidence for the need for streamlined mental health services within reproductive health services.

A stakeholder salience perspective on performance and management control systems in non-profit organisations

This paper explores the role of management’s perceptions of stakeholder salience in the management of performance in non-profit organisations (NPOs) providing social services. We present a case study of two such NPOs providing intellectual disability services in Ireland to address our research questions; how do NPO managers perceive the importance of stakeholders and how does this perception of stakeholder salience influence the design and use of management control systems (MCS)? Our research draws on stakeholder salience theory to capture management’s salience perceptions of key relevant stakeholders and we use insights gained through a framing of performance as a complex montage of individual stakeholder objectives. This work seeks to develop stakeholder salience theory, suggesting that complexity in stakeholder salience gives rise to a co-existence, or duality, in stakeholder typologies. Stakeholder salience is found to provide a valuable framework for developing insights into MCS and performance constructs in an NPO context. Findings suggest that awareness of stakeholder salience can assist in understanding performance conflicts and tensions captured in salience asymmetries most notably in relation to power. Findings also suggest that MCS design and use reflect management’s perception of stakeholder salience and may work to reinforce the status quo.

Borderline personality disorder: resource utilisation costs in Ireland.

Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs. This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty. Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18-65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million. There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.