Readiness for discharge from subacute mental health units for older people: Using available measures to support clinical decision‐making

Prior to introduction of the Health of the Nation Outcome Scale 65+ (HoNOS65) as a mandated measure, the three subacute mental health units for older people in the present study routinely used the Care Planning Assessment Tool (CPAT) for clinical review and discharge planning. The aims of the present study were to compare these two measures of behavioural change during subacute admissions, to examine associations with discharge readiness, and to assess their overall contributions to discharge planning decisions. This is a prospective, comparative measurement study. HoNOS65 (severity) and CPAT (frequency) behavioural subscale ratings were collected from admission to discharge for older patients with very severe and persistent behavioural and psychological symptoms of dementia. Readiness for discharge data (yes/no), collected from multidisciplinary review meetings, was used as the outcome in all analyses. In combination, these measures achieved only modest positive predictive value (52.8%) but good negative predictive value (90.4%). Consequently, patients above the cut‐point on both measures are reasonably unlikely to be discharge ready. The combined use of a standard outcome measure of severity along with a specialized measure of frequency is recommended to support and enhance discharge planning decisions in this population.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

Psychometric properties of the Dutch version of the Health of the Nation Outcome Scales for older adults (HoNOS 65+) in daily care

Background

The Health of the Nation Outcome Scales (HoNOS) is widely used to evaluate mental health care outcomes. For appropriate use and interpretation in routine clinical practice, further validation of the adapted version for older clients (HoNOS 65+) is needed.

Objective

The aim of this study is to compare scoring profiles produced by different categories of professionals, assess the internal consistency of the sum score and proposed subscales, and concurrent validity of the total sum score of the Dutch version of HoNOS 65+.

Methods

We used baseline data from fourteen mental health care organizations participating in the MEntal health care Monitor Older adults (MEMO), a nationwide routine outcome monitoring system. A total of 767 older clients, referred for gerontopsychiatric disorders, were administered HoNOS 65+ by non-academic (primarily nurses, n = 430) or academic professionals (psychologists/physicians, n = 337). Demographics and full DSM-IV classification, including the Global Assessment of Functioning (GAF), were derived from the electronic medical dossier.

Results

HoNOS 65+ seemed to discriminate between clients with and without a depressive disorder, adjustment disorder, anxiety disorder and psychotic disorder on the items expected. In clients suffering from a depressive or psychotic disorder, nurses/social workers and physicians/psychologists did not differ in scoring on all items of HoNOS 65+. In clients with an adjustment disorder or anxiety disorder, professions differed in rating on two items. Confirmatory Factor Analyses supported neither the factor structure of the original HoNOS nor the initially reported structure of HoNOS 65+ version. Cronbach's alpha of the total sum score was 0.60. Internal consistency of previously identified subscales was low. A new set of subscales could not be identified satisfactorily. A medium-sized correlation of the HoNOS 65+ sum score and the GAF was found (r = −.30, p < .001).

Conclusions

It is preferable to use individual HoNOS 65+ items, to evaluate care outcomes. The HoNOS 65+ items discriminate between clients with and without a particular diagnosis. Nonetheless, in some of the most prevalent gerontopsychiatric disorders rating differs between professionals with different educational backgrounds.     

The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia

Although the number of mental health presentations to emergency departments is increasing as a result of the integration of psychiatric services with general services, few studies have explored the characteristics of mental health patients presenting to emergency departments in Australia. This study investigated the characteristics of, and outcomes in relation to, people presenting with a mental health problem to one large metropolitan emergency department. Data were collected from the emergency department's electronic records system for adult patients aged 18-65 years old with an emergency department discharge diagnosis of a mental health disorder, including substance abuse and psychosocial crisis, for two months. Mental health patients totalled 5.3% (n= 290) of adult presentations to the emergency department. Over half were male; mean age 37.4 years; 49% were allocated triage category 3/urgent; 45% arrived by ambulance; 39% were overdosed/intoxicated and 55% received one or more diagnostic investigations. Patients who were intoxicated, those who arrived after hours, or patients admitted to a mental health ward were more likely to wait longer than 8h. Findings are broadly in line with that reported for other Australian studies, although the present findings suggest that patients had significantly more routine investigations and there were higher rates of presentations for 'intoxication'.     

Variation in seclusion rates across New Zealand's specialist mental health services: Are sociodemographic and clinical factors influencing this?

Rates of seclusion vary across New Zealand's publicly funded district health board (DHB) adult mental health inpatient services as indicated by national data. Anecdotally, this variation has been attributed to a range of factors directly relating to the people admitted to acute inpatient services. This study examined the extent to which variation in seclusion rates could be explained by the sociodemographic and clinical differences between populations admitted into adult mental health inpatient services. Retrospective data were obtained from the Programme for the Integration of Mental Health Data (PRIMHD). A logistic regression model was fitted to these data, with seclusion (yes/no) as the dependent variable and DHB groups as the independent variable. The DHBs were classified into four groups based on their seclusion rates. The model adjusted for ethnicity, age, number of bed nights, total Health of the Nation Outcome Scales (HoNOS) scores, and compulsory treatment status. Odds ratios remained virtually unchanged after adjustment for sociodemographic and clinical factors. People admitted to DHB Group 4 (highest secluding DHBs) were 11 times more likely to be secluded than people in Group 1 (lowest secluding DHBs), adjusted OR = 11.1, 95% CI [7.5,16.4], P < 0.001. Results indicate DHB variation in seclusion rates cannot be attributed to the sociodemographic and clinical factors of people admitted into DHB adult mental health inpatient services. Instead, this variation may be explained by differences in service delivery models and practice approaches. A model of system improvements aimed at reducing seclusion is discussed.     

New directions in mental health practice with older people: Canadian strategies for mental health reform

Aim and objective.  The purpose of this article is to draw attention to problems in the Canadian health system that must be overcome if Canada is to ensure that older people can access the services they need.
Background.  Projections suggest that 20% of Canadians will be aged 65+ by 2021. If current prevalence rates for mental illness continue, this will result in a significant increase in the number of older Canadians with or at risk for mental illness and mental health problems.
Design.  Findings of the final report of the Standing Committee on Social Affairs, Science and Technology are summarized and related to the intended role and primary strategy of the proposed Canadian Mental Health Commission.
Methods.  The relevance of the Interprofessional Education for Collaborative Patient-Centred Practice initiative launched by Health Canada is then considered in light of the intention that the Commission adopt collaboration with relevant stakeholders as its primary strategy for achieving mental health reform.
Conclusions.  Fragmentation in service delivery must be overcome if older Canadians are to receive age appropriate mental health services when and where they need them. Yet there is little evidence that the degree of interprofessional collaboration required can be achieved.
Relevance to clinical practice The reforms advocated by the Senate Committee are widely embraced but evidence is needed on how mental health and other professionals can best learn to work together in the interests of older people and other mental health consumers.     

Physical health status of older adults with severe mental illness: The PHiSMI‐E cohort study

The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross‐sectional study design is performed by using baseline data from the Physical Health in SMI‐elderly (PHiSMI‐E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle – Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety‐nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0–10) indicating participants’ self‐perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long‐term health outcomes of these patients.     

Effect of aging on the perceptions of physical and mental health in an Australian population

The aim of this study was to examine the impact of age on the perceptions of mental and physical health in an Australian population. A cross-sectional study of the Queensland population was conducted via telephone interviews (n = 1165). The Short Form-12 Health Survey was used to measure the population's perceived physical and mental health and additional demographic information was collected. Groups with participants who were aged 18-24, 25-34, 35-44, 45-54, 55-64, and > 65 years were compared. The results suggested that the participants' perceptions of mental health gradually increased with age, as the 55-64 and > 65 years old age groups scored significantly higher than did the younger age groups. Conversely, the older participants scored significantly lower than the younger participants on the physical health scale. Further research is warranted to consider the factors that might influence the perceptions of mental health across the life span.     

Mental health nurse practitioners in Australia: improving access to quality mental health care

Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority 'area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners.     

Practitioner attitudes towards patients in forensic mental health settings

Scotland has a national programme to improve mental health and well-being and addressing stigma among mental health practitioners is a priority. This study explores practitioner attitudes towards patients in medium and low secure forensic mental health settings through qualitative and quantitative approaches. Two questionnaires were used with nursing staff. A qualitative questionnaire asked participants to list examples of positive and negative practice and anti-discriminatory and discriminatory attitudes towards patients within forensic services. A quantitative questionnaire then asked participants to answer questions about a hypothetical man with schizophrenia called Harry. The overall balance of responses was more positive than negative in the qualitative results, particularly regarding patient rights, empowerment and control. However, there were a significant minority of negative attitudes in relation to recovery pessimism and desire for social distance. This was supported by the quantitative results where practitioners showed high stigma scores for avoidance and segregation. There were no significant differences in attitudes between medium and low secure settings. However overall, males reported more negative attitudes in relation to blame and avoidance and younger participants demonstrated more negative attitudes than older participants in relation to fear and danger. The implications for addressing stigma are discussed in relation to the wider national anti-stigma campaign and forensic services specifically.     

心理干预对康复期精神分裂症患者心理健康状况的影响

目的探讨心理干预对康复期精神分裂症患者心理健康状况的影响。方法对52例康复期精神分裂症患者在常规药物治疗和护理的基础上进行心理干预，观察6w。心理干预前及干预6w末采用症状自评量表评定患者的心理健康状况，并与国内成人常模进行对比分析。结果康复期精神分裂症患者心理干预前症状自评量表各因子分均显著高于国内成人常模（P〈0．01）；心理干预6w末除偏执因子分无显著变化外，其他各因子分均较心理干预前有显著性下降（P〈0.01～0．05），与国内成人常模比较，除恐怖因子分有显著性差异（P〈0．05）外，其他各因子分均无显著性差异（P〉0．05）。结论心理干预能显著改善精神分裂症患者的心理健康状况，提高其人际交往能力和生活质量。     

Needs and risks of patients in a state‐wide inpatient forensic mental health population

Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales‐Secure; HoNOS‐Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need‐Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS‐Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS‐Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed.     

Development and validation of clinical indicators for mental health nursing practice

A national study was undertaken in Australia to develop and validate a set of clinical indicators for mental health nursing. Using survey and action research procedures, the indicators were developed in two stages. During stage one, focus group interviews involving 39 nurses were conducted at national conferences in Australia and New Zealand in order to provide a pool of indicator statements. A Delphi survey of an Australian sample of mental health nurses (n = 33) was then conducted to refine the indicators. In stage two, the refined indicators were tested and validated in selected clinical settings. A total of 1751 mental health nurses employed at 14 sites were involved in the second stage of the study. The resulting data were used to establish the set of national indicators that the Australian and New Zealand College of Mental Health Nurses will use in practice accreditation and benchmarking.     

流动人口精神病患者家属心理健康状况调查及心理干预效果评价

目的：探讨流动人口精神病患者家属的心理健康状况及心理干预效果。方法对100名流动人口精神病患者家属于患者入院时采用焦虑自评量表和抑郁自评量表评定心理健康状况,根据测评结果予以有针对性的心理干预,于患者出院时再次进行测评分析。结果本组62．0％的患者家属存在不同程度的焦虑抑郁情绪;心理干预前焦虑自评量表和抑郁自评量表总分显著高于国内常模（ t＝21．19、19．14,P＜0．01）,心理干预后较心理干预前显著降低（ t＝14．92、11．08,P＜0．01）,但仍显著高于国内常模（ t＝6．93、6．34,P＜0．01）。结论流动人口精神病患者家属存在不同程度的焦虑抑郁情绪,对其开展有针对性的心理干预能缓解其焦虑抑郁情绪,提高心理健康水平。     

Implementing a major stream in mental health nursing: Barriers to effectiveness

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In‐depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy – in some instances, leading to the programme's termination – and must be assertively addressed to maximize the potential of the major in mental health nursing.     

Quantification and examination of depression-related mental health literacy

Objective  The aim of the study was to create an algorithm to measure depression-related mental health literacy.
Method  Participants were those recruited for the 1998 and 2004 South Australian Health Omnibus Surveys. Two unprompted questions were selected from a mental health literacy questionnaire and responses were quantified through allocation of scores agreed by a focus group of mental health professionals.
Results  An application of the algorithm resulted in findings consistent with those of other research, providing face validity for the method developed. The application allowed for examination of overall levels of depression-related mental health literacy, with improvement found between 1998 and 2004. Similarly, differences in overall literacy according to demographics were also uncovered.
Conclusions  Tracking mental health literacy within populations is important as it has been shown to be related to individual help-seeking as well as provision of support for those with a mental disorder. The method devised in this study allows for comparisons of literacy levels to be made across populations and time. It also offers increased capacity for statistical application.     

患者的自我认知评价对心理健康状况的影响分析

目的了解患者自我认识评价对心理健康状况的影响。方法采用症状自评量表(SCL-90),对65名住院患者进行调查(其中有效问卷64份)。结果患者的心理健康水平低于全国常模。自评情绪越稳定、应对方式越积极的患者,其心理健康水平越高。结论医护人员或心理学工作者可以通过帮助患者提高情绪调节的能力,学习积极的应对方式,提高其心理健康水平。     

Factorial structure of the Health of the Nation Outcome Scales: An ordinal confirmatory factor analysis using a national sample of clinician ratings in England

In the present study, the superior factorial structure of the Health of the Nation Outcome Scales (HoNOS) was investigated. The aims of the study were to test the fit of our new four‐factor/subscale structure within and across a wide range of clinical populations compared to competing structures, and to identify any clinical populations where the HoNOS might require modification in order to improve its psychometric properties. Ordinal confirmatory factor analysis was performed for four competing HoNOS subscale structures using a national sample of 80 161ratings taken at the point of referral to mental health services in England. A new four‐factor structure with good/acceptable internal consistency for each of the factors/subscales demonstrated a significantly better fit to the data for 21 of the 24 data groups compared to three competing subscale models. A new four‐factor/subscale structure was shown to be the most generalizable subscale structure currently available for HoNOS. However, although superior to other factorial structures, the statistical fit was less than optimal for some clinical populations. Therefore, we would recommend that additional items relevant to all mental health patients are identified and added to the HoNOS in order to allow the development of a single, more generalizable subscale structure, and a much improved version of the HoNOS.