Is there a role for music therapy in the recovery approach in mental health?

The recovery approach in mental health care emphasises the importance of the service user leading a fulfilling, meaningful life beyond the limitations of illness or symptomatology. This approach to care is increasingly included as a central part of mental health policy and service provision in a number of countries including the UK and Ireland, to address the needs of people who have severe and enduring mental disorders. It is an autonomous, holistic and empowering way of working with individuals as they journey towards healing. Fundamental to this model is the relationship fostered between service users and health professionals. The recovery philosophy of care mirrors some of the core principles of music therapy, including the importance of the therapeutic relationship and the possibilities for change and growth within this. This paper explores the congruence between music therapy and the recovery approach by providing: (1) An overview of current published evidence for music therapy in mental health care. (2) A discussion of this psycho-social creative arts therapy intervention within the specialized area of recovery in psychiatry, and (3) case vignettes to illustrate the application of this philosophy in music therapy work within a recovery service.     

Allied health care in Parkinson's disease: Referral,consultation, and professional expertise

There is evidence for the efficacy of allied health care in Parkinson's disease (PD). However, barriers exist that hamper implementation of evidence into daily practice. We conducted a survey to investigate: (1) to what extent PD patients currently utilize allied health care for relevant problems in the core areas of allied health care and (2) the level of PD‐specific expertise among allied health professionals. Questionnaires were sent to 260 patients and 297 allied health professionals. Referral rates were 63% for physical therapy, 9% for occupational therapy, and 14% for speech therapy. PD patients with problems that can potentially be alleviated by input from allied health professionals are often not being referred. Furthermore, most patients were treated by allied health professionals who lacked PD‐specific expertise. Current referral to and delivery of allied health care in PD are suboptimal. Evidence‐based guidelines for allied health care in PD and active implementation of these guidelines are needed. © 2008 Movement Disorder Society     

Coping with everyday reality: mental health professionals' reflections on the care provided in an acute psychiatric ward

There is little research evidence about how the mental health professionals are coping with the complexity of everyday practice in psychiatric acute care. The aim of this study was to explore mental health professionals' reflections on their work on an acute psychiatric ward. Data were collected using participant observation and interview methods. Three core themes were identified from a qualitative hermeneutic analysis. The first core theme, coping with uncertainty, uncovered a dialectical pattern of the factors contributing to thriving and strain in the working situation. The second core theme, caring for the patient, included the caring process, patients' pathway to acute psychiatric care, as well as the patients' needs and roles on the ward. The third core theme, coping strategies, included five different methods the primary nursing system, concealing versus integrating, milieu therapy, seclusion and the medical orientated model. It was concluded that good mental health care is a result of collaboration between health professionals and the health services. This study highlights the need for support to professionals and for establishing structures that will enable collaboration to take place. Taken together, this may contribute to enhancing the care of the patient and their families.     

Kathleen Mears Memorial Lecture: innovative research for the END allied healthcare professional

Electroneurodiagnostic technologists play a key role in health care. It is time for these allied health professionals to make a commitment and contribution, using scientific methodology, to the body of medical research and publication. Research methods, quantitative, qualitative, and mixed research design will be reviewed. Introduced is an innovative research approach that is applicable to END practice; it is called, action research.     

Psychosomatic rehabilitation. Self-image, rehabilitative concepts, psychotherapeutic approaches, need vs. demand issues

To provide optimal medical care for patients with psychosomatic disorders, rehabilitation and acute medicine should be viewed as separate but related parts of one overall health care concept. Psychosomatic rehabilitation now plays a major role in the care of chronically ill patients beyond the framework of traditional medical psychotherapy. The self image and rehabilitative concepts of this field are strongly influenced by two cornerstones of psychotherapy: psychodynamics and behavioral science. In the past the main factors used to define requirements for inpatient care were the capacity of existing facilities and the degree of their utilization; what was and still is lacking is an expert assessment of real demand. By offering programs for a broad spectrum of chronic disorders, the field of psychosomatic rehabilitation has achieved impressive therapeutic results at moderate cost; this assertion is substantiated by numerous analyses of the health care system. However, the high quality standard in the field of psychosomatic rehabilitation is currently endangered by politically motivated economic measures and the accompanying reduction of therapy time. If this counterproductive trend is not halted, the inevitable outcome will be suboptimal--in particular for chronically ill patients. In conclusion, possibilities are outlined for improved networking among professionals in psychosomatic rehabilitation.     

Music and healing in cancer care: A survey of supportive care providers

This paper explores the role of music activity and music therapy in health care drawing on a survey of UK cancer care providers offering music interventions and music therapy. The survey examined the extent and type of music provision and explored providers’ views about the role and contribution of music and music therapy in healing. As well as music, the survey organisations offered a range of supportive therapies including complementary and alternative therapies (CAM) and creative therapies such as art therapy. The results provide insight into the way in which music and creative therapies are viewed by those responsible for care provision in this sector. The data point towards some of the challenges facing music therapists in the changing world of cancer care. These include responding to changes arising from developments in treatment and the organisation of care as well as increased collaboration with a diverse range of supportive care practitioners. These include providers of music and arts for health activity as well as complementary and alternative therapy practitioners who are increasingly involved in cancer care provision. We discuss the implications of these changes for the development of music therapy in cancer care.     

Clinical evaluation of patients with head trauma

Head trauma is a very common and sometimes life-threatening medical condition that involves sports medicine physicians, emergency room physicians, neurologists, neurosurgeons, orthopedists, anesthesiologists, rehabilitation physicians, psychiatrists, and radiologists; as well as allied health care workers such as physical, occupational, and speech therapists, clinical psychologists, neuropsychologists, and many others. Head trauma needs to be approached by a mutlidisciplinary team because it is complex. Specialized trauma centers incorporate all of these specialists and the best medical technology for optimal management of head trauma. The following chapters cover the use of different neuroimaging techniques, including CT scan and MRI, that greatly aid clinicians in evaluation and management of head trauma patients. These advances have truly revolutionized medicine and it has happened rapidly--pneumoencephalography was the neuroimaging study of choice less than half a century ago. The future of neuroimaging in head trauma will undoubtedly include advances we can not yet foresee but that will allow clinicians to continue to improve patient care.     

Music-based intervention in children

Music-based interventions with children are an effective method in health and sickness treatment and in education systems. The engagement with music enables positive transfer effects on extra-musical developmental domains. Music therapy was applied primarily as a practically-oriented scientific discipline both within the framework of a multi-modal therapy approach as one treatment component and focused specifically on children with emotional disorders within a somatic therapy concept and in rehabilitation. The following narrative overview will present music therapy's working basis, treatment goals, and select outcome research in children from 2005-2010. There currently exists a substantial lack, even within empirical research, in relation to the application of music therapy to children. This is an opportunity to initiate a broad range of study for the future. Current challenges and opportunities in scientific, music-based intervention in the paediatric population lie in the concretization of differential indications (both in intervention approach and duration), replicable comparative therapy (alternated treatment-design), the application of a music-therapeutic placebo requirement, as well as in the verification and analysis of specific music therapeutic mechanisms.     

Music therapy with patients in low awareness states: approaches to assessment and treatment in multidisciplinary care

This paper outlines the rationale for and role of music therapy as a clinical intervention and diagnostic tool in multidisciplinary (MDT) rehabilitation programmes for patients in low awareness states. A review of the literature indicates that music is a useful clinical tool in stimulating a range of behavioural, physiological and expressive responses in patients in low awareness states. Referral criteria for music therapy with this patient group are provided, along with suggested methods for collaborative multidisciplinary work. A case vignette is presented of a client whose diagnosis of vegetative state (VS) was contradicted by her purposeful responses within music therapy assessment, contributing towards a changed diagnosis to minimally conscious state (MCS). The case illustrates the particular role of music therapy in assisting with diagnosis in complex cases. Music therapy provides a clinical forum in which recovery of function can be assessed in an informal way, using a medium which does not rely on language, is non-evasive and elicits emotional responses.     

Music and epilepsy: a critical review

The effect of music on patients with epileptic seizures is complex and at present poorly understood. Clinical studies suggest that the processing of music within the human brain involves numerous cortical areas, extending beyond Heschl's gyrus and working within connected networks. These networks could be recruited during a seizure manifesting as musical phenomena. Similarly, if certain areas within the network are hyperexcitable, then there is a potential that particular sounds or certain music could act as epileptogenic triggers. This occurs in the case of musicogenic epilepsy, whereby seizures are triggered by music. Although it appears that this condition is rare, the exact prevalence is unknown, as often patients do not implicate music as an epileptogenic trigger and routine electroencephalography does not use sound in seizure provocation. Music therapy for refractory epilepsy remains controversial, and further research is needed to explore the potential anticonvulsant role of music. Dopaminergic system modulation and the ambivalent action of cognitive and sensory input in ictogenesis may provide possible theories for the dichotomous proconvulsant and anticonvulsant role of music in epilepsy. The effect of antiepileptic drugs and surgery on musicality should not be underestimated. Altered pitch perception in relation to carbamazepine is rare, but health care professionals should discuss this risk or consider alternative medication particularly if the patient is a professional musician or native-born Japanese. Studies observing the effect of epilepsy surgery on musicality suggest a risk with right temporal lobectomy, although the extent of this risk and correlation to size and area of resection need further delineation. This potential risk may bring into question whether tests on musical perception and memory should form part of the preoperative neuropsychological workup for patients embarking on surgery, particularly that of the right temporal lobe.     

The challenges of integration in health care research

The team approach in neuroscience patient care results in health care professionals interacting on a daily basis. However, the collaboration of health care disciplines in research is limited. The barrier to research integration among disciplines may be related to the diverse views of the quantitative and qualitative paradigms. Health care research is challenged by both the variety of health professionals and differing research paradigms. Patients will benefit from integrated health care research with a coordinated research agenda and efficient use of resources.     

Pharmacologic options for the management of multiple sclerosis symptoms

Multiple sclerosis (MS) is a disease with a wide-ranging impact on physical functioning. Although pharmacotherapy plays an indispensable role in the management of MS symptoms, optimal disease management requires a multidisciplinary approach that combines medication, rehabilitation, and patient education. Successful control of symptoms is critical to quality of life for MS patients. Immunomodulating drugs provide a means of controlling the underlying disease process, but they are not a cure. This places responsibility on health care providers to control a patient's MS-related symptoms to limit disability and delay impairment in the activities of daily living. Owing to the importance of symptom control, comprehensive patient evaluations should be performed at regular intervals to determine the extent of neurological damage and disease progression and to address changing patient needs. The goal of interventions should be not only to treat the primary and secondary symptoms of MS but also to provide access to the psychosocial support that will help MS patients and their families continue to cope as disease status changes.     

Interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule

OBJECTIVE: Australian mental health policy aims to introduce evidence-based practice within a community care approach. This aim requires reliable measures that can be used by a wide variety of professionals. The interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) was assessed under routine conditions. METHOD: Three interviewer-observer dyads assessed the needs of 14 inpatients and 18 day patients of a psychiatric rehabilitation unit in New South Wales, Australia. RESULTS: Agreement on the identification of an area of need was high. However, agreement was higher on patient ratings than on staff ratings. Correlations on staff ratings of met needs were also moderate (r = 0.53), suggesting discrepancies in rating the level of need. CONCLUSION: Differences in staff ratings may be attributed to ambiguity in the definition of need and levels of need and/or the sources of information used by the rater making the assessment. An approach to establishing an operational definition of need is suggested, and an increase in the number of levels of need is recommended. Implications for Australian mental health policy are noted.     

Better outcomes in mental health care: impact of different models of psychological service provision on patient outcomes

OBJECTIVE: One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals. This paper examines the extent to which the projects are achieving positive patient outcomes, and explores the association between different models of service delivery and varying levels of patient outcomes. METHOD: The paper draws on two data sources (a purpose-designed minimum dataset and a survey of models of service delivery) to examine the level of patient outcomes within and across projects, and variations in the level of patient outcomes by models of service delivery. RESULTS: The projects are achieving positive effects and these are mostly of large or medium magnitude. The projects do not differ markedly in terms of the patient outcomes they are achieving, despite differences in the models of service delivery they are using. However, those projects implementing a direct referral model, where the GP refers the patient directly to the allied health professional, have significantly greater effect sizes, indicating that they are achieving greater improvements in patient outcomes. In addition, there are non-significant trends toward direct employment of allied health professionals by Divisions being predictive of greater improvements in patient outcomes, and delivery of services from allied health professionals' own rooms being predictive of weaker patient outcomes. CONCLUSIONS: Overwhelmingly, the Access to Allied Psychological Services projects are having a positive impact for patients in terms of their level of functioning, severity of symptoms and/or quality of life. Preliminary indications suggest that a service delivery model incorporating the use of a direct referral system may be associated with superior outcomes. The findings are discussed in the light of the imminent listing of psychologists' services on the Medicare Benefits Schedule.     

Clinical Problems in Community Mental Health Care for Patients with Severe Borderline Personality Disorder

The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase Delphi-procedure to identify and prioritize the problems. A total of 36 problems reflecting five categories was found: patient-related, professional-related, interaction-related, social system-related, and mental health care-related. Problems with attachment and dependency and social issues were important patient problems while a lack of skills was an important professional problem. Support from the patient’s social system and the mental health system were identified as limited, which resulted in both the patient and the professional feeling isolated. Patient, professional, and organisational characteristics of community care differ substantially from those of specialized care. The field is thus in need of a more tailored approach that takes these differences into account.     

Using telerehabilitation to promote TBI recovery and transfer of knowledge

Advances in the design and delivery of trauma care and acute medical management have increased the number of survivors of traumatic brain injury (TBI), producing societal consequences and medical challenges. Although access to health care for rural patients remains a critical challenge, teletherapy may represent a viable means for the delivery of therapeutic services to such patients. A case study is presented in which teletherapy was successfully utilized to improve the functional outcomes, both physical and cognitive, of a patient with a severe TBI. A physical therapist from a metropolitan rehabilitation center employed teletherapy to provide Neuro Developmental Treatment for a patient and to mentor staff in a nursing home located over 100 miles from the metro area. The patient, who participated in 48 physical teletherapy sessions over a 24-week period, demonstrated improvements in physical functioning and neuropsychological status. During the course of therapy, goals were adjusted upward to match the patient's improvements. This case study provides confirmatory evidence that teletherapy represents an effective and efficient means for providing rehabilitation services for patients in rural communities, as well as for facilitating mentoring relationships between seasoned professionals and trainees located in rural settings.     

Optimizing stroke systems of care by enhancing transitions across care environments

Stroke affects many aspects of the lives of stroke survivors and their family caregivers. Supporting long-term recovery and rehabilitation are necessary to help stroke survivors adapt to living with the effects of stroke and to help family members adapt to the caregiving role. During recovery and rehabilitation, many elements of the health care continuum are utilized, including emergency response, acute care, inpatient and outpatient rehabilitation, and community and long-term care. With the advent of thrombolytic therapy and the benefits of stroke units, stroke survival and outcomes are improving. As a result, the current emphasis of stroke system improvement is to implement stroke units throughout the developed world. To enhance the patient centeredness of stroke care delivery, an important next phase of stroke system improvement will center on the experiences of stroke survivors and their family caregivers as they move through diverse care environments. The objective of this article was to conduct a scoping review of the literature on stroke transitions to identify the current areas of research emphasis. This article highlights stroke survivors' and family caregivers' experiences with transitions across care environment and some potential strategies to improve those transitions.     

Management and rehabilitation of sexually exploitive therapists

State legislators and mental health professionals in Minnesota have been active in developing strategies to improve reporting, management, and rehabilitation of sexually exploitive therapists. In 1985 and 1986, the legislature criminalized sexual contact by a therapist with a current or emotionally dependent former patient, established sexual exploitation by a therapist as a statutory cause of action, and required that all licensed health professionals report to the Board of Medical Examiners any physician who engages in sexual or sexually suggestive contact with a patient. The Walk-In Counseling Center, a nonprofit agency in Minneapolis, has taken an active role in evaluating exploitive therapists for licensing boards and employers to determine their rehabilitation potential. Mental health professionals and lawmakers have also collaborated in the development of strategies for preventing sexual exploitation and abuse by therapists.     

Rehabilitation of the pediatric patient with a neuromuscular disease

A rehabilitation program for a patient with a neuromuscular disease can be developed only after an accurate diagnosis has been established. The diagnosis and its ramifications should suggest a natural course of disease which, it is hoped, can be improved upon with a rational and realistic program. The program is best developed by an interdisciplinary team, including a pediatric neurologist, who should have the greatest understanding of the patient's problem and should ultimately be responsible for the implementation and monitoring of the program. A child with cerebral palsy commonly requires the services of physical and occupational therapists as well as knowledgeable orthopedists. Is the program appropriate? Does it consider the child's potential as well as his limitations? A child with a traumatic brain injury requires, in addition to the above, psychological intervention and an intensive educational program. Will the child and family need help from mental health professionals? A child with a motor unit disease such as Duchenne's muscular dystrophy requires, in addition to the above services, a "philosophy" of care. Will the child ever ambulate independently? If so, at what cost? What will be necessary for the child to reach this potential, including items such as orthoses and adaptive equipment? Will respirator care become necessary? What issues must be addressed for this form of care to be established? There is no one program for all children. The programs must be individualized to meet the needs of the patient and the family. This point cannot be overemphasized.     

Clinical management. Clinical management units. Management agreements

Clinical management (CM) as a concept includes different innovating experiences in health care services management among developed countries, which were initiated during the late eighties and the first nineties. They were mostly due to the concern that political leaders had about their financial viability. CM, as far as it is understood in Spain, is an organizing model which considers the patient as the centre of the health system. It is guided towards disease, looking for continuous assistance and facilitates an autonomous management together with decentralization at the time of taking decisions. It involves professionals whose clinical practice, based on guides, medical records and care planning, incorporate the knowledge and methodology of "evidence based medicine". Clinical management units (CMU) are organizational types of CM, which implantation is spreading rapidly in the different national health care systems. They include a person who assumes responsibility for them, who act as the hospital directorship interlocutor and are autonomous at the time of managing the allocated resources related to their medical programmes and services. They have an information system adapted to their own needs and an outcome evaluation system which allows them "process" re-engineering. CMU's strengths and weaknesses are highly dependent on the professionals that integrate them. The CMU responsible carries out a management contract with the hospital directorship in which CMU competences, directorship's obligations, essential aspects to meet agreed goals, an outcome evaluation system and an incentives scheme are included.