Early psychosis treatment in an integrated model within an adult mental health service

ObjectiveTo compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service.MethodVariables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program.ResultsCompared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P = 0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts.ConclusionsThe introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.     

Organizational conflict and mental health service system effectiveness

Conflict is a common feature of mental health delivery systems. However, there are many types of conflict and each requires specification and careful measurement. The authors present a study of mental health delivery systems in eight Oregon counties and the results of five conflict parameters that measured conflict with seriously mentally ill clients, family members, the state mental health division, county agencies, and professional/advocate agencies. Implications of the findings for countywide service systems are discussed.This research was supported by the National Institute of Mental Health, MH-14583, Oscar Grusky, Program Director, and ROI MH-38887, Oscar Grusky, principal investigator. A revised version of this paper was presented at the XXXth International Congress of the International Institute of Sociology, Kobe, Japan, in 1991. An earlier version of this paper was also presented to Prof. Steven Segal's NIMH-supported training program at University of California, Berkeley. We are grateful for that group's suggestions and especially grateful to Lance Egley who prompted us to change one of our instruments and also offered other valuable comments.     

The consequences of an open referral system to a community mental health service

The first 590 patients referred to a community mental health service (the Early Intervention Service) in an inner-city district were separated into groups based on their referral source. The service has an open referral system allowing any agency (including patients) to contact the service by letter or by telephone, and priority is given to patients with serious mental illness. The results of open referral showed that the number of referrals was adequate for the service to process, the proportion of inappropriate referrals was similar in all referral agencies, and milder cases of mental illness were referred more often from doctors than from other agencies. It is concluded that an open referral system is likely to be more sensitive to need and has some advantage over closed referral arrangements in inner-city areas.     

Beyond state hospital unitization: the development of an integrated mental health management system

As commissioner of the Massachusetts Department of Mental Health, the senior author in 1975 initiated a reorganization of the department designed to provide greater continuity of care for deinstitutionalized patients by integrating management of hospital and community services at a local level. The new system continued the practice of dividing hospitals into units corresponding to geographical catchment areas (unitization), but it abolished the hospital superintendent's position and greatly broadened the role of the area directors of community services to include clinical administration of the hospital unit serving patients in catchment areas. The authors believe the new system played a role in reorienting the department's services toward community care of the seriously disabled patient and led to a more effective distribution of departmental resources.     

Patient and carer perceptions of need and associations with care-giving burden in an integrated adult mental health service

OBJECTIVE: To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. METHOD: The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. RESULTS: When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. CONCLUSIONS: Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.     

Working across boundaries: clinical outcomes for an integrated mental health service for people with intellectual disabilities

Background The Mental Health Service for People with Learning Disabilities (MHSPLD) is a service development in keeping with UK government policy that promotes cross agency working and access to mainstream mental health services for people with intellectual disabilities. We aimed to show whether the service model brought about improvements in people’s mental state and level of functioning. Method Community and inpatient groups were compared across three time points using a range of clinical outcome measures that assessed psychiatric symptoms, risk, needs and level of functioning. Results Inpatients and community groups had similar mental health problems, but inpatients had higher unmet needs and lower functioning, and were at greater risk. There were significant improvements across the range of outcome measures in both groups. Conclusions Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.     

Preliminary outcomes from an integrated mental health primary care team

The effects of establishing a multidisciplinary mental health primary care team in a Veterans Affairs internal medicine primary care clinic were evaluated. The multidisciplinary team worked in collaboration with primary care providers to evaluate and treat their patients, who had a wide variety of psychiatric disorders, in the primary care clinic. In the first year of operation preliminary outcomes indicated that the rate of referrals to specialty mental health care dropped from 38 percent to 14 percent. The mean number of appointments with the team for evaluation and stabilization was 2.5. These outcomes suggest that a multidisciplinary mental health primary care team can rapidly evaluate and stabilize patients with a wide range of psychiatric disorders, reduce the number of referrals to specialty mental health care, and improve collaborative care.     

Managing mental health service contracts

This article describes managing mental health service contracts. Specific strategies or methods are selected based on their fit with the organization's overall framework, congruence with internal strengths and external opportunities, and the potential to complement and strengthen service strategies. Criteria are proposed for deciding whether a strategic management approach is useful.At the time of writing he was at the Cuyahoga County Community Mental Health Board in Cleveland, OH, where all co-authors are administrative staff.     

Home-based treatment and psychiatric admission rates: Experience of an adult community mental health service in Ireland

Objectives. This study assessed the impact of the introduction of a Home-Based Treatment (HBT) Service on hospital admission rates from two adjacent sectors within a mental health service. Methods. This study used a naturalistic design to compare admissions into the acute inpatient psychiatric unit of Cavan General Hospital from two differently configured sectors - East and West Cavan Psychiatric sectors (East was a community-based and oriented service while the West was a more hospital-based service) prior to and following the introduction of a shared home-based treatment team. Data including demographics, date of admission, diagnosis at admission and sector of admission were retrospectively collected from a mental health register of hospital admissions between 1995 and 2002. Data was analysed using SPSS version 13 for windows. Results. There was a 50% reduction in admission to the inpatient unit in the first two years of the introduction of HBT. This drop was more marked in the West sector compared to the East. Conclusions. The introduction of HBT resulted in a marked reduction in overall hospital admission rates and this reduction was also evident in the sector where other elements of a modern community mental health service already existed.     

Quality of housing among patients of an area mental health service

OBJECTIVES: The aims of the present study were to (i) assess the quality of housing for patients receiving treatment from an area mental health service; (ii) compare estimates of quality of housing using two different methods: housing type versus housing characteristics; (iii) determine whether either method for assessing quality is more useful that a combination; and (iv) examine the relationship between housing quality and case manager's assessment of the impact of the housing on the patient's mental disorder. METHODS: A survey was developed that included the demographics of the patient; housing type; living arrangements; housing characteristics as assessed by the patient's case manager; and an overall assessment by the case manager of the impact that the housing has on the patient's mental disorder. Case managers were asked to complete the housing survey on all patients they saw in the community during a 2 week period in 2003. The social worker for the inpatient unit completed the survey for all patients admitted to the inpatient unit over a 3 month period. RESULTS: Surveys were completed for a total of 362 patients. Just under 10% of patients were identified as homeless in that the person either had no housing or was living in a shelter or accommodation frequently associated with homeless persons. Almost half of the patients in the sample had housing that was either not affordable, not secure, not safe or not appropriate to their needs, that is, their housing met at least one of a range of criteria defining poor-quality housing. Sixty-one patients (16.9%) had housing that was considered by their case managers to have a substantial negative impact on their mental illness. CONCLUSIONS: Almost half of the patients treated by an area mental health service appeared to have poor-quality housing. Housing characteristics identified a higher proportion of people with poor-quality housing than did housing type. Case managers' assessments generally failed to identify a potential negative impact of poor quality housing on the person's mental disorder.     

Implementation of integrated mental health care in an urban district of Tokyo]

Japan had a long history of long-term hospital care and is now trying to change it into community-based psychiatry. Implementing comprehensive approach that has already been proven effective through evidence based data in one particular community, one has to overcome several local barriers, if the same approach is to be implemented in different situations, such as differences in socio-cultural background and health care system. This is a report of the activities of Minato Net 21 pointing out the "local barriers" on implementing comprehensive approach in an urban district of Tokyo.     

Family peer support work in an early intervention youth mental health service

This paper describes the evolution of a family peer support programme in an early intervention service in Melbourne, Australia. In response to policy directions from Federal and State governments calling for carer participation in public mental health services, and feedback from the families of young people at Orygen Youth Health, the ‘Families Helping Families’ project was developed. The positive acceptance by families of this innovative programme also warrants further exploration. The programme has overcome many organizational hurdles associated with specifically trained and employed family carers working alongside professional mental health clinicians. This article describes the change processes involved in implementing this programme and documents preliminary expressions of the benefits of family peer support. The contribution of lived experience in treatment and consumer care plans needs rigorous research and evaluation.     

Needs assessment in mental health service planning

This article discusses multiple approaches to mental health needs assessment and the utilization of results in service planning and systems management. Conceptual and methodological issues are described as are the uses of the findings in planning and allocation of resources.