Routine outcome measures in Norway: Only partly implemented

Abstract

Norway has not had any strategy exclusively for the implementation of routine outcome measurement in the mental health services, but some efforts have been made as part of strategies for a national patient register and quality indicators. Fifteen years after the decision to make the rating of the Global Assessment of Functioning scale (GAF) mandatory at admission and discharge of each treatment episode in adult mental health services, this is still not fully implemented. An unknown and probably very low proportion of mental health services use GAF as a routine outcome measure in everyday clinical practice. Well-established electronic patient records in the mental health services and established procedures for reporting routine data to the National Patient Register should make it possible to collect and use routine outcome data. Implementation of routine outcome measurement in mental health services must be done with due emphasis on the critical steps in the various phases of the implementation process. The regional health authorities have a key role in establishing electronic systems that make relevant outcome measurements available in a seamless way for clinicians as well as for patients, and by contributing to a culture where quality and outcome are valued and given priority.     

Routine outcome measures in Germany

Abstract

The German healthcare system offers comprehensive coverage for people with mental illness including inpatient, day hospital and outpatient services. These services are primarily financed through the statutory health and pension insurances. According to legal regulations, providers are required to base their services on current scientific evidence and to continuously assure the quality of their services. This paper gives an overview of recent initiatives to develop, evaluate and disseminate routine outcome measurement (ROM) in service settings in Germany. A large number of projects have shown outcome monitoring to be feasible, and that feedback of outcome may enhance routine care through an improved allocation of treatment resources. However, none of these initiatives have been integrated into routine care on a nationwide or trans-sectoral level, and their sustainability has been limited. This is due to various barriers in a fragmented mental health service system and to the lack of coordinated national or state-level service planning. The time is ripe for a concerted effort including policy-makers to pick up on these initiatives and move them towards wide-spread implementation in routine care accompanied by practice-oriented research including service user involvement.     

Routine outcome measurement in Australia

Abstract

Australia has been implementing routine outcome measurement in its specialized public sector mental health services for over a decade. It uses a range of clinician-rated and consumer-rated measures that are administered at set times during episodes of inpatient, ambulatory and community residential episodes of care. Routine outcome measurement is now embedded in service delivery, and data are made available in a variety of ways to different audiences. These data are used by policy-makers and planners to inform decisions about system-wide reforms, by service managers to monitor quality and effectiveness, and by clinicians to guide clinical decision-making and to promote dialogue with consumers. Consumers, carers and the general community can use these data to ensure that services are accountable for the care they deliver. This paper describes the status quo in Australia with respect to routine outcome measurement, discusses the factors that led to its successful implementation, and considers the steps that are necessary for its continued development.     

Routine outcome measures in Canada

Abstract

Canada is a federal country of 10 provinces and three territories. High level information on mental health conditions and service use has mostly been generated from administrative data collected by provinces and territories. These include four major types – hospital admissions and discharges, physician billings, ambulatory care services, and drug databases. At the national level, the Canadian Institute for Health Information brings together this information to produce indicators of outcome. Although these data provide information on patient and health system characteristics, they do not capture the full spectrum of formal and informal mental healthcare. These include changes in health status, functioning, community integration and quality of life. As a result, some jurisdictions have begun to implement more standardized measures of outcome such as the clinician-rated Health of the Nation Outcome Scales or the inpatient Resident Assessment Instrument – Mental Health. In this paper we provide an overview of mental-health-related data sources in Canada, highlight some of the more progressive practices beginning to emerge, and conclude with some thoughts about how the routine measurement and reporting of mental health outcomes in Canada might be advanced including efforts at engaging both clinicians and decision-makers.     

Personality disorder prevalence and correlates in a whole of nation dataset

Purpose

The epidemiology of personality disorder is poorly understood. This study aims to describe the population in contact with mental health services with a diagnosis of personality disorder and compare service use between this group and those with a diagnosis of depression.

Methods

Investigation of a routinely collected clinical data set across New Zealand was conducted. We used data from 2008 to 2017 and 1-year data from 2016, the most complete dataset. This allowed for variation over the years and confirmation within a 1-year prevalence. These data were analysed focusing on patients with a primary diagnosis of any personality disorder and the subset with borderline personality disorder (BPD). BPD was chosen as the most common clinical personality disorder diagnosis and that most researched.

Results

8884 (2.8%) of the population in contact with mental health services carried a primary diagnosis of personality disorder. Personality diagnosis other than antisocial personality disorder (ASPD) in men and borderline personality disorder (BPD) in either gender was negligible. Rates of personality pathology increased with social deprivation and were commonest in young adults. Multi-morbidity was the norm, with internalising disorder common. Maori diagnosed with PD were over-represented both in the patient group and by population.

Conclusion

Borderline personality disorder and antisocial personality disorder are routinely diagnosed in routine clinical practice in New Zealand; however, other categorical diagnoses are not made. Patients with PD are significant users of resources in comparison to depressed patients. Resource utilisation was significantly greater in those with PD, in particular use of inpatient services compared to those with depression.

     

Routine mental health outcome measurement in the UK

Abstract

This paper offers a short history of routine clinical outcomes measurement (RCOM) in UK mental health services. RCOM developments in primary and secondary care are described, with reference to measures currently in widespread use or likely to be implemented. Assessment procedure and completion rates are discussed. Some of the forces operating in this field are enumerated. Comparison is made with UK attempts at routine outcomes measurement in public education. This field is thus reviewed for lessons for RCOM, and opportunities and challenges considered.     

Health Advocacy- Counting the Costs

Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of different population groups, each with distinct but also similar health needs in the Auckland and Northland regions of New Zealand. The costs of advocating for a fair share of funding for the provision of health advocacy services for approximately a third of New Zealand’s population and the legal journey and involved is discussed as well as the lessons those involved have learnt along the way. A focus is made on the importance of health advocacy to address the health needs of Maori, especially those in mental health services, specialist forensic services and those who are need of mental health care in prison.     

The feasibility of routine outcome measures in mental health

Background: Standardised outcome measures are not being used in routine mental health care. Method: The importance of routine use of standardised outcome measures is argued, and reasons for their lack of use suggested. Results: One reason for standardised outcome measures not being used routinely is the lack of appropriate instruments. This property of being suitable for routine use is often called feasibility, but there is no consensus about the meaning of feasibility, or how it should be measured. We propose a definition of feasibility as a psychometric property of a standardised outcome measure, provide criteria for assessing feasibility, and then present a framework for changing practice to increase the routine use of standardised outcome measures. Conclusions: If mental health care is to maximise outcome, then more attention needs to be paid both to the process of developing and to facilitating the routine clinical use of feasible outcome measures. Accepted: 20 January 1999     

Community mental health services--the New Zealand experience

This overview focuses on a provision of current mental health services in New Zealand and might help professionals from other countries to become familiar with its community based model of care. New Zealand mental health services have undergone significant changes over the last 40 years. These include the closure of old psychiatric hospitals and the development of community based treatment facilities. The New Zealand government has been closely involved with the organisation of mental health services providing strategic directions and financial support. So far much has been accomplished, however some gaps still remain.     

Outcome measures in forensic mental health services: A systematic review of instruments and qualitative evidence synthesis

BackgroundOutcome measurement in forensic mental health services can support service improvement, research, and patient progress evaluation. This systematic review aims to identify instruments available for use as outcome measures in this field and assess the evidence for the most common instruments, specific to the forensic context, which cover multiple outcome domains.MethodsStudies were identified by searching seven online databases. Additional searches were then performed for 10 selected instruments to identify additional information on their psychometric properties. Instrument manuals and gray literature was reviewed for information about instrument development and content validity. The quality of evidence for psychometric properties was summarized for each instrument based on the COnsensus-based Standards for health Measurement INstruments (COSMIN) approach.ResultsA total of 435 different instruments or variants were identified. Psychometric information on the 10 selected instruments was extracted from 103 studies. All 10 instruments had a clinician reported component with only two having patient reported scales. Half of the instruments were primarily focused on risk. No instrument demonstrated adequate psychometric properties in all eight COSMIN categories assessed. Only one instrument, the Camberwell Assessment of Need: Forensic Version, had adequate evidence for its development and content validity. The most evidence was for construct validity, while none was identified for construct stability between groups.ConclusionsDespite the large number of instruments potentially available, evidence for their use as outcome measures in forensic mental health services is limited. Future research and instrument development should involve patients and carers to ensure adequate content validity.     

Employment services as an early intervention for young people with mental illness

Aim: To examine the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand. Methods: The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16–25 years over a 2-year period (2005–2007). These results were compared with recent national and international benchmarks. Results: As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables. Conclusions: Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses.     

医疗人员对居住在新西兰克赖斯特彻奇的中国人的精神卫生服务状况的观点

背景：移民会给人带来压力，也有可能会提高在海外居住的中国人的精神疾病患病率。文化习俗和服务的缺乏也许会阻碍他们寻求所需的精神卫生服务。 目的：评估新西兰的医疗人员关于来自中国大陆的移民对精神卫生服务的使用状况的观点。 方法：本定性研究在新西兰克赖斯特彻奇完成。研究者深入访谈了9名有服务中国客户经验的精神卫生专业人员，并把访谈内容进行笔录以及主题分析。 结果：访谈内容中出现了四个主题：（1）中国移民的特殊心理问题；（2）移民中最容易出现心理问题的人群；（3）妨碍获得服务的因素；（4）社会支持网络对中国移民的心理健康的重要性。 结论：通过对高收入国家中为日益增长的中国大陆移民提供心理健康服务的医疗人员的定性研究，可以找出需要提高对文化的敏感度的地方，以此来增加中国移民对精神卫生服务的利用，提高服务的效率。     

Experiences of living with mental health problems during the COVID-19 pandemic in the UK: a coproduced,participatory qualitative interview study

Purpose

Research is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time.

Methods

We used qualitative interviews (N = 49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team.

Results

Existing mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to the community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health.

Conclusion

There is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.

     

Discrimination and victimization as mediators between social support and psychological distress in autistic adults

BackgroundThe mental health of autistic adults is a critical concern. The aim of this study is to gain a better understanding of how access to professional and social support combines with the experience of discrimination and victimization to explain psychological distress in autistic adults.MethodA cross-sectional online survey was conducted to provide information on psychological distress (Kessler K6), characteristics of the personal social support network, utilization and access to social and professional support, diagnosis and health conditions, and socio-demographic characteristics of the respondents. Two-hundred and twenty-two (222) autistic adults from Quebec (Canada) completed the survey.ResultThe results indicate high rates of psychological distress (51%), significant unmet support needs and many barriers to accessing psychosocial and health services. Four independent serial multiple mediator models confirm that social support and experiences of discrimination and victimization statistically mediate the relationship between professional support and psychological distress.ConclusionsThis study contributes to the understanding of the role of social support in the development of mental health difficulties in autistic people. Several courses of action are proposed, such as the implementation of structural corrective measures for access to services (e.g., limiting waiting times), design of service settings to limit possible sources of hypersensitivity, diversification of appointment methods (telehealth), making general service providers aware of the specific realities and characteristics of autism, greater consideration of the social aspects that influence mental health, the development of peer support programs, and the adoption of a positive and non-ableist view of autism in training programs.     

Research-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19

ObjectiveOlder adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery.MethodsUsing a research-practice partnership model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over 5 months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning.ResultsOur project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals; clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19.ConclusionOur routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.