Unmet needs and treatment seeking in high users of mental health services: role of illness perceptions

OBJECTIVE: A small number of patients tend to use a disproportionately high amount of mental health services. Understanding the needs and behaviours of this group is important in order to improve patient management. Few studies have investigated the role that patients' perceptions about their mental illness play in guiding coping responses and treatment seeking. The aim of the present study was to investigate how illness perceptions in high users of mental health services were related to unmet needs and treatment-seeking behaviours. METHOD: A total of 203 high users of mental health services were interviewed using the Brief Illness Perception Questionnaire, the Camberwell Assessment of Need and the Drug Attitude Inventory, and were also asked to report the number of visits they had made to the general practitioner in the past year. District Health Board clinical staff completed the Camberwell Assessment of Need and the Global Assessment of Functioning for each user. RESULTS: More negative perceptions about mental illness were associated with higher ratings of unmet needs by both patients and staff. Negative perceptions were also related to poorer attitudes towards medication, and lower functioning. Perceptions about the personal ability to control the illness were consistently associated with better outcomes. Patients' causal attributions could be categorized as social, psychological, biological and behavioural. More frequent visits to the general practitioner were associated with perceptions of more severe symptoms, greater concern and higher emotional responses to the illness, and psychosocial causal attributions. CONCLUSION: Illness perceptions provide a framework to assess patients' ideas about severe mental illness and a means by which to identify maladaptive beliefs. Interventions targeted at changing these beliefs may encourage better self-management.     

农村社区精神卫生服务中初级卫生人员培训的对照研究

农村培训初级医务人员开展精神卫生服务工作，以如何安排为好？我们对此进行了随机整群抽样对照研究。实验组为理论培训并实践中示范辅导，对照组仅为理论培训。评价其理论知识掌握程度，处理病人工作能力及工作质量。一年的随访结果表明：实验组在这三方面都明显好于对照组，表明除多次理论培训外，实践中示范辅导是很重要的培训方法。     

Carers and community mental health services

Background There is a growing appreciation of the role and needs of carers for people with mental health problems. Carers are a diverse group, including partners, relatives and friends who are seen as such by service users. Methods Sixty-four carers of people with severe mental health problems served by four different mental health care providers were interviewed using the Experiences of Care-giving Inventory. The districts were selected to differentiate services that are targeted at more severely impaired users from those that include a wider spectrum, and to contrast services that have greater integration between health and social care providers with those whose health and social care agencies operate relatively discretely. Results In the two districts where service users had more severe mental health problems, carers worried more about negative symptoms and thought less about good aspects of the caring relationship. In the two districts where health and social services worked more closely together, carers worried significantly less about the need to back up services. Conclusions These findings suggest that service organisation can affect carers, in particular that integration between health and social care for people with mental health problems may benefit carers in ways that were hitherto unproven. They highlight the needs of carers for younger people. They show that the ECI is a useful instrument in measuring the impact of caring for people with severe mental health problems. Accepted: 19 September 2001     

Governing boards in mental health: Roles and training needs

This paper emphasizes the importance of a mental health center board's assuming responsibility for directing its effort to objectives that are different from that of the staff and suggests a framework for such differentiation. The authors describe a study on boards and its implications for the training of board members.     

Unit costs of community mental health services

The unit (hourly) costs of delivering services for six community mental health agencies in the greater Portland, Oregon area were computed. The calculations include an explicit methodology for allocating indirect costs associated with clinical services and with administrative overhead. Substantial variation among the six agencies in their unit costs was found and is explained by agency differences in: use of high cost (chiefly medical) personnel, the fraction of time staff spend in direct face-to-face client contact, and numbers of clients in treatment groups. The methodology as well as the results are increasingly important for community mental health programs in the era of managed mental health care.This study was partially supported by National Institute of Mental Health grant numbers P50 MH43458 and R01 MH45015.     

韩国社区精神卫生服务的印象

<正>自上世纪80年代起,随着韩国工业的迅猛发展,其精神卫生服务机构及住院病床数也迅速提升,到90年代中期韩国政府提出社区康复理念,并于首尔建立第一个社区精神卫生中心。随后,很多省市也建立起社区精神卫生机构。其社区服务理念注重"以病人为中心",对精神病患者"轻症状"、"重全人",并将这一理念深入到医疗康复服务的每一细节,对患者病情、身体状况、居住情况、经济能力、劳动能力、生活能力、人际关系等进行综合评估,再结     

Responsibilities and training needs of mental health administrators

This paper reports findings of a needs assessment in the area of training programs for senior mental health administrators. Questionnaires (N=530) were sent; 169 to county and regional state mental health administrators; 331 went to community mental health administrators. The response rate was 43%. Thirty-four percent of the public sector respondents listed general administration as their first topic; fiscal issues were listed by 19%; 18% listed personnel administration first. Second topics chosen for training by the public sector administrators were general administration (17%), financial management (24%), and personnel (20%). As their first topics of choice for future training, 37% of the community mental health administrators selected general administration areas, 27% selected financial management, and 10% personnel. Training for mental health administrators has the potential for substantial enrichment through the design and implementation of carefully planned programs. Results from this needs assessment show the continued strong need for such training.     

The nature of needs assessment in community mental health

Confusion in defining needs assessment is discussed. A tripartite model of needs assessment is proposed: an identification of a problem; a statement about priorities; and a chosen solution. The parts can be used independently or linked together to plan new or altered services. Various needs assessment techniques are examined for their usefulness in each area. Two examples of needs assessment processes are given.     

社区心理卫生服务研究进展

目前生活节奏快,竞争压力日益增加,各种不良的心理应激因素也相应增加,越来越多地影响人们的生活质量和健康水平,人们也开始关注如何保持良好的心态,对心理健康服务的需求日益增大。现代社区心理卫生服务起源于20世纪五六十年代的西方发达国家,它是由临床心理学和社会心理学交叉而形成的一门较新的心理学科。现在,社区心理卫生服务已在全球发展并在发达地区渐趋完善,社区心理卫生服务机构已成为人们预防、治疗心理疾患的重要场所。     

Community mental health services in the community jail

A frequently neglected group of community residents are those who find their way into jail. Jails tend to be the collecting point for many disturbed persons. This paper briefly describes the problems of the jail population and staff and suggests a policy of mental health intervention. To illustrate these points, the Mental Health Project in the Salt Lake County Jail is described as an example.