Implementation of Treatment Guidelines for Specialist Mental Health Care

Although treatment guidelines are commonly employed in healthcare settings, it remains unclear whether their use has any positive impact on the performance of mental health services or whether they improve patient outcomes. This systematic review is based on a search carried out in March 2012 and includes 5 randomized studies that examined the effectiveness of guideline implementation strategies in improving healthcare services and outcomes for people with mental illness. The 5 studies were generally at unclear risk of bias, and all evidence in the “Summary of Findings” table was graded by review authors as of very low quality. Although single studies provided initial evidence that implementation of treatment guidelines may achieve small changes in mental health practice, with only 5 studies meeting inclusion criteria, and with limited usable information, it is not possible to arrive at definitive conclusions. A gap in knowledge still exists about how guideline implementation strategies might improve patient outcomes and health services. This leaves scant information for people with mental health problems, health professionals, and policy makers. More large-scale, well-designed and well-conducted studies are necessary to fill this gap in knowledge.Key words: guidelines/, implementation/, schizophrenia     

Perceptions of Overall Mental Health and Barriers to Mental Health Treatment Among US Older Adults

ObjectivesWe surveyed older adults about their perceived mental health and their comfort discussing and engaging in mental health treatment.MethodsA nationally representative survey of community-dwelling older adults aged 50–80 (N = 2,021), with respondents asked to rate their current mental health as compared to 20 years ago, comfort discussing their mental health, and potential hesitations to seeking treatment in the future.ResultsAbout 79.6% reported their mental health as the same or better than 20 years ago; 18.6% reported their mental health to be worse. Most respondents reported that they were comfortable (87.3%) discussing their mental health, preferring to discuss such concerns with their primary care provider (30.6%). About 28.5% of respondents did endorse some hesitation seeking mental health care in the future.ConclusionsMost older adults reported that their mental health was as good if not better than it was 20 years ago and felt comfortable discussing mental health concerns.     

Association Between Disability Measures and Short-term Health Care Costs Following Intracerebral Hemorrhage

Background and Purpose  Small improvements in clinical outcomes after intracerebral hemorrhage (ICH) can have a substantial impact on overall health care costs, yet little data exists on the costs associated with the most commonly studied clinical outcomes in this type of stroke. Methods  The Factor Seven for Acute Hemorrhagic Stroke (FAST) trial was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. The resource utilization associated with health care services was prospectively recorded in all patients up to day 90 after stroke onset. Measures of disability included the modified Rankin Scale (mRS), and the Barthel Index (BI), while the National Institutes of Health Stroke Scale (NIHSS) measured neurological impairment. Relationships among resource use, health care costs, and disability/impairment were evaluated using one-way ANOVA with Bonferroni testing. Results  A total of 820 patients had complete data. Length of stay (LOS) and total costs varied significantly by mRS scores at 90 days (P < 0.0001). Mean LOS for mRS scores 0–5 and dead were 16, 29, 40, 61, 80, 79, and 14 days, respectively; all categories of mRS had significantly different total LOS from their adjacent categories except mRS 0–1 and mRS 4–5. Mean total costs were $9,500, $15,500, $18,700, $27,400, $27,300, $27,300, and $8,100, respectively; costs rose incrementally up to mRS 3, but were not significantly different for mRS 3, 4, and 5. Total LOS and total costs varied significantly by the Barthel Index scores (P < 0.0001) and NIHSS scores (P < 0.0001), yet significant incremental differences were only observed for the Barthel Index. Conclusion  Health care costs vary significantly by levels of disability as measured by the mRS, but costs do not vary across the full range of mRS outcomes. The mRS is more informative than the Barthel index and NIHSS for discriminating the resource use and costs associated with different levels of disability after ICH. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Unmet Mental Health Care Needs for Children with Special Health Care Needs Stratified by Socioeconomic Status

Background:  The purpose of this research study was to identify factors that affect mental health care for children with special health care needs (CSHCN) and to identify how these factors vary among different socioeconomic levels.
Methods:  Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. The analysis examined the relationships of demographic characteristics, geographical location of household, severity of condition, and social factors on unmet need for mental health care. Multiple logistic regression models were constructed for four socioeconomic status (SES) levels defined by the federal poverty level (FPL): <133%; 133–199%; 200–299%; ≥300%. Standardised regression coefficients were calculated to compare among SES strata.
Results:  There were 38,866 CSHCNs represented in the survey with 9,639 needing mental health care in the past 12 months. The household income distribution was 22% below the 133% FPL, 15% between 133–199% FPL, 18% between 200–299% FPL, and 45% at or above 300% FPL. Black race, ethnicity, insurance type/status, geographical location of household, and number of kids in the household were significant in the <133% of FPL stratum for predicting having received all needed mental health care in the last 12 months. Age and geographical location of household were significant in the 133–199% of FPL stratum. Maternal education was significant in the 200–299% of FPL stratum. Severity of condition, other race, and insurance type/status were significant in the ≥300% of FPL stratum.
Conclusions:  Factors affecting unmet needs for mental health care differed by socioeconomic status. Future research should explore a more in-depth picture of the CSHCN population that includes stratification by income groups to better understand and serve this population.     

Community Mental Health Care for Women with Severe Mental Illness Who Are Parents

Women with SMI are involved in childbearing and childrearing, but may have problems with parenting related to symptoms, lack of knowledge and skills, or lack of environmental supports. They may need intensive services to manage their mental illness and to parent to the best of their abilities. Preliminary research suggests that mental health interventions can improve family functioning, but that these services are not widely available in community mental health systems. This paper describes services to help clients who are parents, which includes integration of adult's and children's services, long-term, home-based parent training, and linkage with community supports.     

Mental Health Care Use in Children of Parents with Mental Health Problems: Results of the BELLA Study

Whether parental mental health problems facilitate or hinder the use of mental health care of the parents´ children is still unclear. The present cross sectional study examined mental health care use and potential predictors in a population based sample. Children of parents with mental health problems (CPM) were nearly 5 times more likely to use mental health care compared to children of parents without mental health problems. A multiple regression analysis revealed that the most important predictors of mental health care use for CPM were active family life (OR?=?2.67) and children´s own mental health problems (OR?=?1.18 self-report, 1.17 parent-report). Additionally, parental strain showed a tendency to predict mental health care use (OR?=?2.45). This study demonstrates that parental mental health problems are associated with mental health care use in their children and that improving certain family factors may support children´s mental health care use.     

Training Health Professionals for Child and Adolescent Mental Health Care in Nigeria: A Qualitative Analysis

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration.     

Rethinking the Mental Health Treatment Skills of Primary Care Staff: A Framework for Training and Research

Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.     

Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis

This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.     

Deficiency Citations for Mental Health Care in Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) certifies approximately 17,000 nursing homes per year. When a facility does not meet a standard, a deficiency citation is issued. Using 1998 citations, we examined the structure and process characteristics of nursing homes that were associated with mental health deficiencies. Our findings showed that (a) some nursing homes have a high number of deficiencies in the area of mental health care; (b) these deficiencies do not appear to be associated with specific processes used in nursing homes; and (c) some structural factors such as staffing, private-pay occupancy, and Medicare occupancy appear to have an important influence on the number of mental health care deficiencies.     

Treatment Outcome,Duration, and Costs: A Comparison of Performance Indicators Using Data from Eight Mental Health Care Providers in The Netherlands

Assessing performance of mental health services (MHS) providers merely by their outcomes is insufficient. Process factors, such as treatment cost or duration, should also be considered in a meaningful and thorough analysis of quality of care. The present study aims to examine various performance indicators based on treatment outcome and two process factors: duration and cost of treatment. Data of patients with depression or anxiety from eight Dutch MHS providers were used. Treatment outcome was operationalized as case mix corrected pre-to-posttreatment change scores and as reliable change (improved) and clinical significant change (recovered). Duration and cost were corrected for case mix differences as well. Three performance indicators were calculated and compared: outcome as such, duration per outcome, and cost per outcome. The results showed that performance indicators, which also take process variability into account, reveal larger differences between MHS providers than mere outcome. We recommend to use the three performance indicators in a complementary way. Average pre-to-posttreatment change allows for a simple and straightforward ranking of MHS providers. Duration per outcome informs patients on how MHS providers compare in how quickly symptomatic relief is achieved. Cost per outcome informs MHS providers on how they compare regarding the efficiency of their care. The substantial variation among MHS providers in outcome, treatment duration and cost calls for further exploration of its causes, dissemination of best practices, and continuous quality improvement.     

An Analysis of Australian Mental Health Services for people with Mental retardation

This paper reports the findings of a survey of a representative sample of institutionally based nursing staff who work with patients who have developmental disability (DD). The survey investigated nurses’ knowledge, attitudes, preparation and skills with regard to patients who have dual diagnoses of epilepsy and DD and identified some significant deficiencies in these domains. Based on these findings, the paper indicates a need to establish appropriate training programs for nurses so that the needs of these patients can be better addressed.     

Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection

This study describes persons with serious mental illness and comorbid HIV infection and examines the effect of co-location of mental health and HIV care on satisfaction, service utilization, and appropriateness of care. One hundred and eighteen subjects completed interviews and gave blood samples; medical records were abstracted. Most reported few barriers to care and satisfaction with mental health and HIV treatment. Co-location of mental health and HIV care did not influence satisfaction with care, utilization of services, or appropriateness of care. This report challenges the notion that persons with serious mental illnesses receive inadequate health care and that they have minimal capacity for illness management. These subjects may be benefiting from increased funding for, and attention to, persons with HIV infection.     

Assessing Administrative Costs of Mental Health and Substance Abuse Services

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.     

Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany

Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System (N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.     

The History of Community Mental Health Treatment and Rehabilitation for Persons with Severe Mental Illness

The authors review the evolution of the treatments for persons with severe mental illnesses over the past 40 years in three areas: pharmacological and other somatic treatments, psychosomatic treatments, and rehabilitation. Current treatments are based on a much stronger evidence base, are more patient-centered, and are more likely to target autonomy and recovery.