Self-reported consumer satisfaction in mental health services: Validation of a self-rating version of the UKU-Consumer Satisfaction Rating Scale

The UKU-Consumer Satisfaction Rating Scale (UKU-ConSat) for the evaluation of consumer satisfaction in mental health services was constructed for assessments by independent professional interviewers. In the present study, a patient self-reported version of the scale is validated against the original version. The Spearman's rank correlation between single items, subscores and the total of the original scale and the self-assessment version was found to be good. Another main finding was an acceptable unidimensionality of the self-rating version of the UKU-Consumer Satisfaction rating scale, evaluated by a Mokken analysis. Furthermore, the internal consistency by Cronbach's alpha was found to be satisfactory. The results show that the patient self-rating version is psychometrically sound and therefore suitable for use in ordinary clinical practice. Being a part of a concept for continuous quality control and development in mental health services, the self-rating version of the UKU-ConSat promotes an open collaborative dialogue between professionals and users. A further advantage is that it saves professional time.     

Key priorities,challenges and opportunities to advance an integrated mental health and education research agenda

A critical priority for the fields of education and mental health is to develop an integrated research agenda to advance empirical and practical progress towards the goal of reducing a significant research to practice gap. This study presents qualitative findings from an intensive dialogue meeting held with a multidisciplinary sample of 35 leaders in education, children's mental health and related fields. Comprehensive data from the meeting by three independent notetakers were analysed and integrated to fully capture the discussion of research priorities for education and mental health. Synthesized content represented the three categories of key priorities, challenges and opportunities towards an integrated mental health and education research agenda. Themes identified by qualitative analysis of the notes, as well as suggestions, current progress and future directions for reducing the research-to-practice gap, are described.     

Establishing mental health policy and services in Vanuatu

With a population of 245,000 spread mostly over six groups of islands and a total land area of 12,189 km², Vanuatu is one of the larger Pacific Island countries. Compared to other Pacific Island countries of similar or larger size, mental health has received little attention from government until very recently. While systematic studies are lacking, the limited available data suggest that mental disorders and suicide are increasing. The first ever National Mental Health Policy and Strategic Plan were launched in October 2009. Key areas include formalization of the National Mental Health Committee established in 2007, financing, mental health legislation, service organization, human resources, essential medicines, information systems, quality, advocacy, and monitoring and evaluation. In 2010, mental health was inserted for the first time into the new Ministry of Health organizational structure. The Ministry of Health mandate is to work with partners to achieve sustainable progress in reducing all key risk factors to improve the wellbeing of everybody with mental illness. The country has commenced a program of mental health training for workers at primary and secondary health facilities and community awareness, with support from the World Health Organization Pacific Island Mental Health Network (PIMHnet) and others. A foundation for modern mental health services has been laid.     

Barriers to recruiting ethnic minorities to mental health research: a systematic review

Disparities in the prevalence of mental illness are widely reported for people from ethnic minorities. Unlike the United States, there is no legislation for clinical research in the UK to mandate the inclusion of ethnic minorities and they are underrepresented in European trials compared with those conducted in the United States. This restricts generalization of research findings. This systematic review of the barriers to the recruitment of ethnic minority participants into psychiatric research is based on a comprehensive literature search. Nine included papers explore such barriers based on the authors’ and participants’ experiences of research. These barriers are mainly categorized as: participant related, practical issues, family/community related, health service related and research process issues. This review provides a compilation of important barriers to recruitment which can facilitate future research. The barriers that were identified are not all unique to participants from ethnic minorities, although the way in which they manifest themselves is often distinct in minority groups. It is important that these barriers are considered when designing research design so that solutions to overcome such obstacles can be incorporated in research protocols from the start and appropriate resources allocated. Copyright © 2014 John Wiley & Sons, Ltd.     

Patterns of mental health service utilization in a general hospital and outpatient mental health facilities

Purpose Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost. Subjects and methods 22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000–2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using “high cost” (>7,263$) as dependent variable. Results Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0–14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services. Discussion Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality. Conclusion Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.     

Interdisciplinary research framework for multisectoral mental health policy development

This paper proposes an interdisciplinary research framework for developing mental health policy in countries where a multisectoral approach to population mental health is not yet on the policy agenda. The proposed mental health policy research framework contains two structural elements: research on the policy content and policy process dimensions. The content dimension defines mental health policy as being a multisectoral policy encompassing positive mental health for all, the prevention and treatment of mental disorders, and the social and human rights consequences of poor mental health. The process dimension is based on the cyclical model of policy processes as described by Kingdon’s theory of agenda-setting and Rochefort’s analysis of the factors which affect mental health policy-making. The framework presents an innovative approach to researching mental health policy, bringing a more interdisciplinary focus and an explicit emphasis on policy-making.     

Impact of services,met needs,and service empowerment on consumer outcomes

The current study examined service characteristics, needs, and outcomes of consumers with severe mental disabilities served in a public mental health setting. The study utilized a longitudinal design with three yearly waves of measurement. Data were obtained from consumer interviews and case manager questionnaires. A model specifying relationships between service characteristics, needs, and outcomes was tested using structural equation modeling. This model incorporated service-related variables pertaining to service amounts, service empowerment, and needs in order to gain a better understanding of factors that mediate service effects and account for mental health outcomes. The model focused on consumers' perspectives, in order to highlight the importance of consumers' opinions about their mental health services and needs. The results suggested that consumers' perceptions that their needs are met were related to better symptomatology and quality of life outcomes. In addition, consumers' perceptions that they had some say in service-related decisions had an indirect effect on mental health outcomes by increasing the likelihood that needs were met according to consumers' perspectives. Results were mixed with regard to the effects of these variables on level of functioning outcomes. Service amount was unrelated to mental health outcomes. Furthermore, service amount was unrelated to consumers' perceptions of needs, suggesting that consumers' views regarding met and unmet needs may not be included sufficiently in decision-making surrounding the provision of services.     

Mental health services and research in the Arab world

Although there are 22 Arab countries in the Arab League, the mental health services provided in those countries show several forms of variation. Economic, political, social and cultural factors seem to play a major role in determining the state of the psychiatric profession and the access of the service to citizens. The different needs expressed by Arab colleagues at times seem incompatible with the available allocated resources. Some Arab countries enjoy the highest income per capita, yet this is inconsistent with the quality of mental health services available there. The per capita mental health services, the availability of a Mental Health Act, and the space allocated for mental health in medical curricula are but a few of the concerns that have been expressed by colleagues from the different countries of the Arab region. The following review will attempt to draw up a profile of the situation for mental health services and research in the region, and to suggest some measures for intervention.     

Developing partnerships in mental health to bridge the research-practitioner gap

PURPOSE. An overview of approaches used in contemporary mental health research to consider when coordinating research agendas is presented. Connections between the research–practice gap and evidence‐based practice are explored. Collaboration, as a key concept and practice, is investigated particularly in relation to community and consumer participation in mental health research. CONCLUSIONS. Non‐commensurate belief systems, inadequate infrastructure, and institutional tendencies maintain the status quo and constitute significant impediments to widespread planned and integrated research programs. PRACTICE IMPLICATIONS. Communication and trust building between researchers and practitioners is central to developing effective collaborations that can deliver more effective health care.     

The current state of mental health care in Italy: problems,perspectives, and lessons to learn

After legislative changes in 1978, Italian psychiatry underwent a thorough overhaul, with the gradual closure of all Mental Hospitals. A nation-wide network of Departments of Mental Health now deliver outpatient and inpatient care, but also run semi-residential and residential facilities (the latter with 2.9 beds per 10,000 inhabitants). Hospital care is delivered through small psychiatric units (with no more than 15 beds). There are also many private inpatient facilities operating in Italy, and the number of private inpatient beds per 10,000 inhabitants exceeds the number of public beds; overall there are 1.7 acute beds per 10,000 inhabitants—one of Europe’s currently lowest numbers. There is marked quanti- and qualitative variation in the provision of out- and inpatient care throughout the country, and service utilization patterns are similarly uneven. Studies examining quality of life report a fairly high degree of patient satisfaction, whereas patients’ families frequently bear a heavy burden. In conclusion, the Italian reform law led to the establishment of a broad network of facilities to meet diverse care needs. Further efforts are required to improve quality of care and to develop a more effectively integrated system. Greater attention must be paid to topics such as quality of care and outcomes, public and private sector balance, and the coordination of various resources and agencies.     

From our perspective: consumer researchers speak abut their experience in a community mental health research project

People who have experienced the mental health system were hired and trained as researchers in a community mental health research project. Throughout the course of the project, these consumer researchers reflected on what they learned about their research experience. This article is a window into this learning process and offers an opportunity to see research through the eyes of consumer researchers. We begin by giving an overview of the research project and introducing the research team. Then the consumer researchers in our project share their experiences and insights about involving mental health consumers in research projects. We hope that ourproject's experiences will help other projects that involve consumers in ways that are empowering for the consumer and beneficial to the research.     

Racism and mental health and the role of mental health professionals

The concept of “race” and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be “the others,” who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of “the other” on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of “race” is genetically incorrect. Therefore, the implicit racism that underlies many established “scientific” paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.     

Creating an innovative youth mental health service in the United Kingdom: The Norfolk Youth Service

Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and “youth‐friendly” service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social‐recovery oriented, evidence‐based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth‐oriented.     

Taking evidence-based practices to school: using expert opinion to develop a brief,evidence-informed school-based mental health intervention

School-based mental health services offer unparalleled opportunities for providing accessible care to children and adolescents. Research indicates that services available in schools are rarely based on evidence of effectiveness and are typically disconnected from the larger school context. To address these issues, the current paper presents initial studies to inform the development of a brief, evidence-based, flexible mental health intervention that fits the school context while maintaining clear structure. Results from two qualitative research studies – key informant interviews with school mental health experts and a nominal group decision-making process with stakeholders – are presented, both of which were aimed at informing intervention development and testing assumptions about how best to design an effective, context-specific mental health intervention that can be flexibly applied in educational settings. An explicit focus on educational outcomes within the context of mental health service delivery was identified as a key component of this integration. The paper concludes with a discussion of how this research has influenced the ongoing development of the intervention protocol, exemplifying a collaborative and iterative approach to developing school-based programmes.     

Conducting clinical research in community mental health settings: Opportunities and challenges

Tremendous progress has been made in the past decade surrounding the underlying mechanisms and treatment of neuropsychiatric disease. Technological advancements and a broadened research paradigm have contributed to the understanding of the neurochemistry, brain function and brain circuitry involved in neuropsychiatric disorders. The predominant area of unmet medical need in the United States is major psychiatric disorders, and major depressive disorder is the leading cause of disability for ages 15-44. Total spending on research and development by the pharmaceutical industry has grown exponentially during the past decade, but fewer new molecular entities (NME) for the treatment of major psychiatric disorders have received regulatory approvals compared to other therapeutic areas. Though significant expansion has occurred during the “decade of the brain”, the translation of clinical trials outcomes into the community mental health setting is deficient. Randomized controlled trials (RCTs) have been the standard approach to clinical evaluation of the safety and efficacy of NMEs for the past 60 years; however, there are significant barriers and skepticism in the implementation of evidence-based outcomes into clinical practice. Recruitment of patients, shortages of experienced clinical researchers, regulatory requirements and later translation of outcomes into clinical practice are ever growing problems faced by investigators. The community mental health setting presents particular barriers in the replication of therapeutic outcomes from RCTs. The diagnostic complexity of major psychiatric diseases and the highly selective patient populations involved in clinical trials lend to the gap in translation from the “bench to the bedside”. The community mental health setting lends to a diverse patient population with numerous co-morbidities and environmental factors that are unaccounted in the average RCT. While we acknowledge the enormous complexity in developing novel and innovative treatments for major psychiatric disorders, we must continue to improve the translatability of clinical trials to real world settings. Progress has been rather slow but as the gap in treatment effectiveness is reduced, so will costs and barriers in community mental health.     

Establishing and operating an early intervention service for psychosis in a defined catchment area of northwestern Greece within the context of the local mental health network

Aim: The study aims to present briefly the development of an early intervention service (EIS) for psychosis in a rural catchment area of north‐western Greece within the context of the local mental health network, its structure and procedures, and the results of its operation 2 years after its establishment. Method: Established in December 2007, our EIS is the first service in Greece for patients with a first‐episode psychosis. The context and the local mental health network are described, and the EIS operation, including clinical, educational, community and research activities, is outlined. Assessment measures are presented to evaluate the EIS progress 2 years after its establishment. Results: Between December 2007 and December 2009, EIS received 45 referrals, retaining 38 patients in its caseload. The mean duration of untreated psychosis was 26.6 ± 41.0 months (median = 12 months). Thirty‐seven patients (82.2%) were hospitalized after their first referral, 14 under a compulsory order (31.1%). The duration of hospitalization ranged from 2 to 69 days, with a median of 13 days. Mean (±SD) duration of the follow‐up was 14.8 ± 8.5 months, indicating adequate adherence to EIS, with particularly low relapse rates (20%). Conclusions: Our EIS seems to be successfully established within the local mental health network. Our collaboration with the local mobile mental health unit enabled our communication with rural primary healthcare centers. The collaboration of patients' family and the participation of the mobile mental health unit to the continuity of care contributed greatly to the brief duration of hospitalization and the high adherence to follow‐up rates.