Implementation of a model for service delivery and organisation in mental healthcare: a qualitative exploration of service provider views

The purpose of the present study was to investigate factors influencing the implementation of a model for service delivery and organisation in mental healthcare. A qualitative case-study approach was employed involving in-depth interviews with 25 service providers from across mental health and social care in one local authority area in northern England. Purposive sampling achieved a broad coverage across geographical areas, voluntary and statutory services, and primary, secondary and specialist mental healthcare. The findings indicate that implementation was influenced by three interrelated factors: the means by which the model was introduced to the workforce; use of the model itself by service providers; and the broader service context. Thus, negative reactions to the way the model was initially presented strongly influenced service providers' subsequent views of it. Moreover, observations regarding the broader context of mental healthcare revealed a service that was ill-equipped to manage change because of over-stretched resources and that was disinclined to accept imposed change because of poor staff morale. Finally, differential interpretation of the model's tiers by service providers led to defensive practice that manifested itself as over-referral of service users within the system. Changing practice behaviour is a complex process, particularly at a service level that consists of numerous professional groups with differing cultural norms. Successful reorganisation of services is unlikely if those responsible for delivering care are not part of the process of change. Moreover, unsuccessful attempts to change professional practice may exacerbate existing tensions within a workforce, which may be to the detriment of those requiring care. A full diagnostic analysis of the system, including service providers' concerns, should be carried out before introducing change or reconfiguring services.     

A 'bittersweet pill to swallow': learning from mental health service users' responses to compulsory community care in England

Two forms of compulsory mental healthcare and supervision in the community are provided within the Mental Health Act 1983: Supervised Discharge Orders (SDOs) and guardianship. At a time when the Government are proposing to extend powers of supervision over people with severe mental illness in the community, it is appropriate that service users' experiences of existing legislation are examined and reported. Despite a range of literature that presents mental health service users' views and experiences, it remains unclear how service users respond to compulsory community mental healthcare in England. The present paper presents the findings of a qualitative investigation into service users' perceptions and experiences of living with SDOs. In the interviews, service users communicated their understanding of why mental health professionals placed them on the order and how their lives have been affected. Individual service users are capable of seemingly contradictory responses, simultaneously accepting and resisting the orders. This paper presents a typology of the range of responses. These responses are fatalism and resignation, dependency, ownership, bargaining, cooperation, resistance, and rejection. The study provides a model with which we can begin to understand how service users respond to compulsory community care where their options are legally constrained.     

留守儿童生存质量与心理健康的相关性及影响因素分析

目的 分析留守儿童生存质量与心理健康的相关性及留守儿童生存质量的影响因素,为改善留守儿童生存质量提供理论依据。方法 2017年9月-2020年9月抽取本地区某小学四年级至六年级208名留守儿童进行调查,用儿童生存质量普适性核心量表(PedsQL4.0)评价留守儿童生存质量,用心理健康诊断测验(MHT)评价留守儿童心理健康状况。用Pearson相关分析法分析留守儿童生存质量与心理健康的相关性,用多元线性逐步回归模型分析影响留守儿童生存质量的因素。结果 留守儿童PedsQL4.0量表结果总分为(80.52±9.58)分,MHT测验结果显示总分为(8.27±0.99)分。留守儿童生存质量得分与心理健康得分均呈负相关(P＜0.05)。多因素分析显示影响留守儿童生存质量总分的因素有照顾者受教育程度、有无兴趣爱好、与父母联系频率、父母外出务工时间(β=3.122、4.057、2.524、-2.018,P＜0.05)。结论 留守儿童生存质量与心理健康密切相关,照顾者受教育程度、有无兴趣爱好、与父母联系频率、父母外出务工时间等因素均能影响留守儿童生存质量。     

精神健康服务的最新研究探析

精神健康对于个人、社会和国家的整体福利来说是至关重要的。传统的精神病院将逐渐关闭,被组织良好并承担预防和治疗精神健康问题的社区所取代,更多地意识到精神健康的切入点在社区而非医院。     

Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review

Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing-related independent variables and health-related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Twenty-nine studies met the suitability criteria, of which 14 reported healthcare utilisation outcomes; 12 examined mental status outcomes; and 9 reported quality-of-life outcomes. The findings of the review suggest that there is good evidence that housing interventions benefit the homeless population; however more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasising longitudinal designs that focus on participant retention and by implementing matched control groups or randomised interventions to strengthen internal validity. Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimises harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.     

社区卫生服务中心在提升社区老人生活质量中的作用及对策

目的 :通过对上海曹杨社区500位老年人生活质量的调查分析,结合社区卫生服务中心在社区老年人居家养老中的功能定位,探索适宜社区老年人居家养老模式,进一步提升社区老年人的生活幸福指数。方法 :采用纽芬兰纪念大学幸福度量表和老年人生活质量评定量表,对500例上海市某社区的老年居民进行问卷调查,研究老年人生活质量的现状及影响因素。结果 :对老年人生活质量影响较大的是心理及社会因素,如情绪、家庭关系、人际关系、社会活动等。社区卫生服务中心可在现有资源下积极参与。结论 :政府及护理机构应深化社区护理模式的研究,社区卫生服务中心提供"以人为本"的社区护理服务,开展个性化的护理照顾,把关注老年人心理活动和提供更丰富的社会支持作为社区护理发展的重要内容。     

头颈部癌患者心理状况与生存质量关系

目的 探讨头颈部癌治疗后患者心理状况与生存质量之间的关系。方法 对中国人民解放军济南军区第四五六医院肿瘤科复诊的110例头颈部癌术后或放化疗后的患者及105名健康对照进行问卷调查。结果 头颈部癌患者生存质量总分为(717.45±109.63)分,对照组总分为(867±90.64)分,头颈部癌患者各个领域生存质量指标均低于对照组,差异有统计学意义(P<0.05);Spearman相关分析表明,焦虑及抑郁与患者生存质量大多数维度呈相关关系(P<0.05);Logistic回归分析表明,抑郁、焦虑是患者生存质量的主要影响因素,标准回归系数分别为-0.597、-0.830;头颈部癌患者心理状况与生存质量密切相关。结论 心理干预可作为生存质量的干预手段之一;改善患者的心理状况可以提高其生存质量水平。     

Establishing an innovative model of nutrition and dietetic care for a mental health service through collaboration with non-nutrition healthcare workers

Aim:  To describe the process of the development of the Web-based resources to extend nutrition care to mental health patients through existing non-nutrition mental healthcare professionals (case-managers).
Methods:  A formative approach was used to identify nutrition-related issues faced by both patients and staff through a synthesis of literature review, professional experience and clinical observations. Decision-making tools to assist case-managers in selecting resources were developed to guide case-managers' choice of effective evidence-based health education materials on the hospital intranet. Practical training was provided for case-managers during their orientation to the new website and the tools and resources it housed.
Results:  A Web-based nutrition site was created on the Royal Brisbane and Women's Hospital intranet. The website consisted of a Nutrition Referral Action Plan (a patient support triaging flowchart), a Nutrition Support Action Plan (action-based nutrition support tool to guide resource selection) and thirteen action-based nutrition education resources.
Conclusion:  By maximising established patient contact through existing health professionals, a Web-based approach to nutrition service delivery was an innovative method for delivering patient information. This collaborative action-based strategy has the potential to raise the nutrition profile in mental health and extend nutrition services to at-risk patients not previously receiving nutrition care.     

Symptoms,functioning and quality of life after treatment in a residential sub‐acute mental health service in Australia

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery‐focused, sub‐acute service, in Australia. Clients were either step‐up clients, entering the service directly from the community, or step‐down clients who were transitioning from an inpatient unit to home. During the 30‐month period of data collection (August 2011 to January 2014) all clients (N = 102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis‐32) and service providers completed the Life Skills Profile‐16 and Health of the Nations Outcome Scales. Follow‐up data 3 months after exit were available for 12 clients, including the Basis‐32 and a self‐report measure of quality of life (Assessment of Quality of Life 8‐dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self‐care, level of symptoms and presence of social problems. At 3 months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub‐acute service, step‐up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step‐down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub‐acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital.     

The development of a community child and family mental health service

The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.     

Working atmosphere,job satisfaction and individual characteristics of community mental health professionals in integrated care

Working requirements of community mental healthcare professionals in integrated care are complex. There is a lack of research concerning the relation of job satisfaction, working atmosphere and individual characteristics. For the current study, a survey evaluating job satisfaction and working atmosphere of mental healthcare professionals in integrated care was performed. About 321 community mental healthcare professionals were included in the survey; the response rate was 59.5%. The professional background of community mental healthcare professionals included nursing, social work and psychology. Community mental healthcare professionals reported the highest satisfaction with colleagues and the lowest satisfaction with income. Moreover, it could be shown that more responsibility, more recognition and more variety in job tasks lead to an increase of overall job satisfaction. Healthcare for mentally ill patients in the community setting is complex and requires well‐structured care with appropriate responsibilities within the team. A co‐operative relationship among colleagues as well as clearly defined responsibilities seem to be the key for the job satisfaction of community mental healthcare professionals in integrated care.     

婚前医学检查医师的基本素质与健康教育的关系

目的：探讨健康教育作为婚前技术服务的法定内容和重要策略，在实施婚前保健工作中的作用。方法：利用现代促进型健康教育模式。开展目标人群的健康教育。结果：健康教育有利于保障母婴健康，有利于帮助人们转变不良健康行为，有利于提高婚前保健服务质量。结论：健康教育已成为母婴保健服务的重要组成部份，在婚前保健中显得尤为突出，并提出从事这项工作的婚检医师应在伦理道德，业务能力等素质方面加强自身的提高。     

A new patient focused index for measuring quality of life in persons with severe and persistent mental illness

The quality of life in persons with severe and persistent mental illness is often poor. Most treatment programmes have the goal of increasing quality of life. Unfortunately, existing methods to assess qualtiy of life are cumbersome and oriented towards research rather than clinical settings. This study describes preliminary steps in the development, testing and application of a new patient focused index for measuring quality of life in persons with severe mental illness. The Quality of Life Index for Mental Health (QLI-MH) differs from existing instruments in that it is based on an easy to use, self-administered questionnaire that assesses nine separate domains that together encompass quality of life. Each domain can be individually weighted depending on its relative importance to the patient. Different parts of the instrument solicit information from the patient, the primary clinician and, when available, the family. The instrument and its scoring system address limitations of previous approaches to quality of life measurement.     

Associations between exposure to ambient photochemical oxidants and the vitality or mental health domain of the health related quality of life

BACKGROUND: Ambient air pollution may affect the health related quality of life (HRQOL) of people, as assessed by the vitality (VT) and mental health (MH) domains of the SF-36 health survey (SF-36). METHODS: In a nationwide survey, 4500 people aged 20 years and older were selected from the entire population of Japan by stratified random sampling in October 2002. A total of 2896 subjects filled out the self administered questionnaire that included the SF-36 and demographic characteristics. Data were linked from the questionnaires with the data on air pollutants in the cities where the subjects resided. The paper examined the relations between the mean concentration of each air pollutant and the VT or MH score on the SF-36 using analysis of covariance. RESULTS: On crude analysis, the respondents who were exposed to a higher mean two month concentration of photochemical oxidants (Ox) showed a significant linear trend toward lower VT score (p = 0.028). This association remained even after adjustment for subjective demographic characteristics and meteorological variables (p = 0.033). There was a common tendency that subjects who were exposed to higher concentrations of Ox had a lower mean VT or MH score; however, there was a significant association only between Ox concentration and VT score. CONCLUSION: The score on the VT domain of the SF-36 was associated with the mean concentration of Ox during the previous two month period. Assessing the health effects of air pollution by measuring the HRQOL, such as by using the SF-36, may provide a new method of formulating air pollution policies.     

Impact of Medicaid reimbursement on mental health quality indicators

OBJECTIVE: To examine the relationship between the use of the Minimum Data Set (MDS) for determining Medicaid reimbursement to nursing facilities and the MDS Quality Indicators examining nursing facility residents' mental health. DATA SOURCES: The 2004 National MDS facility Quality Indicator reports served as the dependent variables. Explanatory variables were based on the 2004 Online Survey Certification and Reporting system (OSCAR) and an examination of existing reports, a review of the State Medicaid Plans, and State Medicaid personnel. STUDY DESIGN: Multilevel regression models were used to account for the hierarchical structure of the data. DATA COLLECTION: MDS and OSCAR data were linked by facility identifiers and subsequently linked with state-level variables. PRINCIPAL FINDINGS: The use of the MDS for determining Medicaid reimbursement was associated with higher (poorer) quality indicator values for all four mental health quality indicators examined. This effect was not found in four comparison quality indicators. CONCLUSIONS: The findings indicate that documentation of mental health symptoms may be influenced by economic incentives. Policy makers should be cautioned from using these measures as the basis for decision making, such as with pay-for-performance initiatives.     

个性化生命质量测量及其在卫生服务领域的应用

本文从个性化生命质量测量的概念、内容、应用及发展前景等方面出发,介绍个性化生命质量测量工具。个性化生命质量能反映研究对象的个人感知和对健康的关注点。个性化生命质量测量工具在国外已有较广泛的应用,但是国内相关研究缺乏。个性化生命质量测量能敏感、准确地评价特定人群有关生活状态的感受,是疾病管理、健康管理和卫生政策制定的适宜工具。     

The relationship between proxy reported health-related quality of life and parental distress: gender differences

Objective Although primary caregiver proxy reports of health‐related quality of life (HRQOL) are often used for healthcare decision making when child self‐reports are unable to be collected (because of a variety of reasons such as child illness, disability or age), we have little understanding of the correlates of parent‐proxy reports. The aim of this study was to examine the relationship between parental depression and parent‐proxy reported QOL for primary caregivers (mothers and fathers), using a multidimensional HRQOL instrument. It was hypothesized that maternal depression would be negatively correlated with maternal reported HRQOL, but that paternal depression would not be correlated with paternal reported HRQOL. Methods Data were from parents of children aged 4–5 years (n = 4983) involved in the Longitudinal Study of Australian Children. A questionnaire assessing parental depression (Kessler‐6) and proxy reported HRQOL (Pediatric Quality of Life Inventory) was completed by the primary caregiver. Results For maternal primary caregivers, maternal depression was negatively correlated with all domains of maternal proxy reports of HRQOL (r = ?0.24 to r = ?0.36). For paternal primary caregivers, there was no relationship between paternal depression and paternal proxy reports of HRQOL. Multiple regression analyses demonstrated that maternal depression was a significant predictor of total HRQOL, accounting for 12% of the variance. For paternal mental health, depression did not predict parent‐proxy reported total HRQOL. Conclusion These results highlight the importance of assessing maternal mental health when measuring proxy reported QOL. Further research is needed in this area to examine the relationship between parental depression and proxy reported HRQOL (including both mothers and fathers, where possible), as well as child self‐reported HRQOL.     

高一新生近视对视觉相关生活质量与心理健康影响

目的 探究高一新生近视对视觉相关生活质量与心理健康的影响。方法 选取某职业学校高中一年级的300名学生为调查对象,按近视程度分为正常、轻、中、重分组,分别采用VRQ-25问卷(视功能调查问卷)与SAS(焦虑自评量表)评分对各组视功能相关生活质量与焦虑程度进行评估。结果 对比发现,各组VRQ-25评分随近视程度升高而下降(rs=-0.854),SAS评分随近视程度升高而升高(rs=0.655),以上数据差异具有统计学意义(P<0.05)。结论 近视可对高一新生视觉相关生活质量与心理健康造成一定影响,家长与相关部门应高度重视青少年的眼部健康问题。