Applications and usefulness of routine measurement of patients' satisfaction with community-based mental health care

OBJECTIVE: This study was conducted within the framework of the South-Verona Outcome Project (SVOP) in a sample of patients, with the full spectrum of psychiatric diagnoses, who are attending the South-Verona Community-based Mental Health Service (CMHS). It aims to exemplify some applications of routine measurements of service satisfaction and specifically: i) identify strengths and weaknesses, in the patients' perspectives, of a 'real world' service; ii) monitor whether this specific service provides satisfactory care over 3 years and iii) identify if there are any patients' characteristics that might be associated with service dissatisfaction. METHOD: Service satisfaction was measured with the Verona Service Satisfaction Scale (VSSS) across three subsequent waves of the SVOP; frequency distributions of scores in the various VSSS domains were compared. The relationship between satisfaction with psychiatric care and a number of well-established mental health indicators, including socio-demographic, clinical and service intervention variables, was investigated using random-effect models. RESULTS: The organization of service and the behaviour and manners of the professionals were the main service strengths. Weaknesses were identified in the physical layout of facilities, in the lack of involvement of relatives and in the information provided. Overall satisfaction was medium-high, while subjects with longer duration of service contact and higher disability were the most dissatisfied. The predictors we examined, however, explained only modest percentages of variance. CONCLUSION: Repeated, routine assessments of service satisfaction have provided a clear view of the South-Verona CMHS' strengths and weaknesses; this set of information was crucial for the continuous quality improvement process in the service.     

The therapeutic relationship in secondary mental health care: a conceptual review of measures

OBJECTIVE: The study aimed to determine the conceptual basis of measures of the patient-professional relationship used in routine mental health services research by reviewing their face, content and construct validity. METHOD: A comprehensive literature search identified measures of the relationship used in mental health services research. The conceptual basis of each identified measure was identified by a review of measures' authors assessments of face, content and construct validity plus item analysis of the measures themselves. RESULTS: The search identified 15 measures. The seven developed in psychotherapy were likely to be better validated conceptually; most were based on therapeutic alliance models. Measures developed specifically for mental health services were based on a wider range of models including global assessments of the relationship. CONCLUSION: Most of the better validated measures originate in psychotherapy, but there is limited evidence for their validity in general mental health services. Four measures are recommended.     

Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version)

Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G. Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Objective: We report the rationale, reliability, validity and responsiveness studies of the Mental Illness: Clinicians’ Attitudes (MICA) Scale, a 16‐item scale designed to measure attitudes of health care professionals towards people with mental illness. Method: Items were generated through focus groups with service users, carers, medical students and trainee psychiatrists. Psychometric testing was completed in a number of student samples. The responsiveness of the scale was tested after a 1.5 h mental illness stigma related intervention with medical students. Results: The MICA scale showed good internal consistency, α = 0.79. The test–retest reliability (concordance) was 0.80 (95% CI: 0.68–0.91). The standardised response mean for the scale was 0.4 (95% CI 0.02–0.8) after a mental illness related stigma intervention. Conclusion: The MICA scale is a responsive, reliable and valid tool, which can be used in medical education and mental health promotion settings and studies.     

Coordinating mental health care across primary care and schools: ADHD as a case example

Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between health care and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers, which can be applied in both primary care and school settings, are described in this paper. This paper has a primary focus on children with attention-deficit/hyperactivity disorder, but the principles and strategies described are applicable to children with a range of mental health and health conditions.     

Functional connectome mediates the association between sleep disturbance and mental health in preadolescence: A longitudinal mediation study

Sleep disturbance is known to be associated with various mental disorders and often precedes the onset of mental disorders in youth. Given the increasingly acknowledged bidirectional influence between sleep disturbance and mental disorders, we aim to identify a shared neural mechanism that underlies sleep disturbance and mental disorders in preadolescents. We analyzed a dataset of 9,350 9–10 year‐old children, among whom 8,845 had 1‐year follow‐up data, from the Adolescent Brain Cognitive Development (ABCD) study. Linear mixed‐effects models, mediation analysis, and longitudinal mediation analysis were used to investigate the relationship between sleep disturbance, mental disorders, and resting‐state network connectivity. Out of 186 unique connectivities, the effect of total sleep disturbance (TSP, from Sleep Disturbance Scale) and mental problems (MP, from Child Behavior Checklist) converged in the default mode network (DMN) and the dorsal attention network (DAN). Within‐ and between‐network connectivities (DMN‐DAN, DMN‐DMN, DAN‐DAN) mediated the relationship between baseline TSD and MP at 1‐year follow‐up and the relationship between baseline MP and TSD at 1‐year follow‐up. The pathway model in which sleep disturbance and mental problems affect each other through two anticorrelated brain networks (DMN and DAN) suggests a common neural mechanism between them. Longitudinally, a less segregated DMN and DAN is associated with negative outcomes on mental well‐being and sleep disturbance a year later. These findings have important implications for the design of prevention and neurofeedback intervention for mental disorders and sleep problems.     

Public perceptions,explanatory models and service utilisation regarding mental illness and mental health care in Kenya

The degree to which the mental health services are utilized depends partly on the public's views about mental illness and the public's perceptions about the roles of the providers of the services. Therefore, effective implementation of Kenya's mental health policy during the 1990s was likely to be influenced in some degree by how far it was compatible with the public's concepts of mental illness. The aim of this study was thus to explore the conceptual model underlying the views of the Kenyan public about mental illness and relate it to the national mental health policy of 1994. A household survey was conducted using a Key Informant Interview schedule. Results showed that the public subscribed to a biopsychosocial view of mental illness and health care, which was indeed compatible with the mental health policy, which was rooted in the concepts of Primary Health Care, as articulated at Alma Ata. However, the public did not expect biopsychosocial care from the health services, but rather only the biological/pharmacological component, relying on other care providers for psychosocial management. This discrepancy could have impeded the implementation of the 1994 policy.     

From community mental health services to specialized psychiatry: the effects of a change in policy on patient accessibility and care utilization

In 1975, a community mental health (CMH) centre with most of its resources channelled to outpatient services was set up in a defined catchment area of 75,000 inhabitants near Stockholm. In 1981, the CMH centre was allocated 3 inpatient wards of its own. An outpatient unit to treat long-term psychotic patients was also built up from existing resources. Emergency cases were directed to the primary health care services or to the emergency department of a hospital. During the same period, the number of doctors in the area's primary health care services increased fourfold. The social, demographic and diagnostic composition of the patient population and its utilization of in- and outpatient care in connection with these organizational changes are described. The population of the cathment area increased by 12.5% and the patient population decreased by 40%. The decrease was particularly great among first-time visitors (-54%), patients from lower social groups (-53%) and those with crisis diagnosis (-71%). The number of patients with psychoses increased (+26%). Outpatient visits and hospital utilization increased by one third. The number of compulsory admissions increased by 20% (still being far below the mean number in Stockholm). The decrease in the patient population is attributed to the reduction in accessibility to the CMH centre at a time when primary care services in the area were undergoing a sizeable expansion. The increased care utilization is the result of an internal redistribution of resources in favour of resource-demanding, long-term psychotic patients.     

Building mental health promotion capacity in health care: results from Phase I of a workforce development project

The development of mental-health-promoting health care systems is dependent on having a skilled and informed workforce to effectively integrate mental health promotion (MHP) into programme and service delivery. This paper describes Phase I (September 2009-July 2010) of Health Compass, an innovative, multi-phased project that aims to transform health care practice and shift organizational culture by enhancing the capacity of health care providers to further promote patient, client and family mental well-being. Phase I of Health Compass examined the current state of MHP within British Columbia's Provincial Health Service Authority health care services. The findings, based on group discussions and key informant interviews, examined health care providers' current understanding and knowledge of MHP; identified existing strategies, facilitators and barriers that help or hinder the incorporation of MHP into health care practice and services; and identified preferred learning modalities for development and piloting of future MHP resources in Phases II and III.     

Discharge of adolescents with mental health problems against medical advice: Findings from adult mental health inpatient facilities across Ontario,Canada

Little is known about discharge against medical advice (DAMA) among adolescents with mental health problems. The objective of this study was to examine the prevalence of DAMA and provide some insight into the factors that influence DAMA among adolescents with mental health problems using a large dataset from Ontario, Canada. Data on 1811 adolescents aged 14–18 years who were discharged from adult mental health beds between October 2005 and March 2010 were analyzed using logistic regression. Of the 1811 discharges in the sample, 78(4.3%) were against medical advice. In the multivariate model, older age, having limited insight or no insight into mental illness, provisional DSM-IV diagnoses of substance-related disorders, eating disorders, and personality disorders increased the odds of DAMA. Length of stay was negatively associated with DAMA. The findings of this study highlight the importance of completing comprehensive assessments at the time of admission to identify adolescents who are at risk of treatment refusal and provide timely intervention to prevent DAMA.     

French version of the profiles of occupational engagement in people with severe mental illness: Translation,adaptation, and validation

Occupational engagement is affected in many persons with severe mental illness (SMI) because of personal, occupational, and environmental issues. However, no French assessment tool measuring occupational engagement in these persons is currently available. The objectives of the study were to translate the “Profiles of Occupational Engagement in People with Severe Mental Illness” (POES), including a time use diary and an interview, and to measure the interrater reliability of the French version. First, a transcultural validation process of the English version of the POES into French was completed. Second, to determine interrater reliability, ten evaluators assessed 23 participants with an SMI. Specific concepts were clarified with the author of the original tool. No items were added or removed following the translation process. An interview guide was developed to assist the interview on occupational engagement. Analyses indicated high interrater reliability (ICC?=?0.94). French-speaking clinicians will be able to use a validated French version of the POES to better capture occupational engagement in people with SMI, facilitating the individualisation of interventions.