Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017.

OBJECTIVE: The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS: Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS: The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS: Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.

Assessment of need for inpatient treatment for mental disorder among female prisoners: a cross-sectional study of provincially detained women in Ontario.

BACKGROUND: International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. Most will be treated within the prison however the most severely ill require transfer to a hospital facility. The primary aim of our study was to survey the total provincial female prison population in Ontario, Canada, to determine the proportion that require treatment in a psychiatric hospital, and the security level required. The secondary aim was to investigate the validity and psychometric properties of DUNDRUM-1 and DUNDRUM-2 in making these assessments. METHODS: We carried out a cross-sectional study of all remand and sentenced female inmates detained in all 16 provincial jails that hold women in Ontario. The severity of mental health need was categorised by mental health staff on a five-point scale. Two forensic psychiatrists then examined all medical files of prisoners that had been categorised in the highest two categories and a random sample of nearly a quarter of those in the third category. An overall opinion was then made as to whether admission was required, and whether a high intensity bed was needed, and files were rated using DUNDRUM-1 and DUNDRUM-2. RESULTS: There were 643 female inmates in provincial prisons in Ontario. We estimated that approximately 43 (6.7%) required admission to a hospital facility, of which 21.6 [prorated] (3.4%) required a high intensity bed such as a psychiatric intensive care bed within a secure hospital. The DUNDRUM-1 and -2 tools showed good internal validity. Total scores on both DUNDRUM-1 and DUNDRUM-2 were significantly different between those assessed as needing admission and those who did not, and distinguished the level of security required. CONCLUSION: This is the first study to determine level of need for prison to hospital transfers in Canada and can be used to inform service capacity planning. We also found that the DUNDRUM toolkit is useful in determining the threshold and priorities for hospital transfer of female prisoners.

Prevalence and management practice of first generation antipsychotics induced side effects among schizophrenic patients at Amanuel Mental Specialized Hospital, central Ethiopia: cross-sectional study.

BACKGROUND: First-generation antipsychotics (FGAs) are associated with a range of adverse events which can significantly reduce patients' quality of life and contribute to non-adherence. The aim of this study was to assess the prevalence and management practice of first generation antipsychotics induced side effects among schizophrenic patients. METHODS: The study was conducted at Amanuel Mental Specialized Hospital from March to June, 2017. Data from patients were collected using a pretested structured questionnaire. Demographics and side effects of antipsychotics were collected by face to face interview. Clinical characteristics, medications and previous history of adverse drug events were extracted from medical records using data abstraction format. The data were analyzed using statistical software for social sciences (SPSS) version 20. Descriptive statistics and chi-square tests were done. Statistical significance was considered at p < 0.05. RESULTS: Out of 356 participants, 300 of them had complete data and were included in the study. The mean age of participants was 33.71 ± 10.2 years. The majority, 195(65.0%), of participants were males. Most of the participants, 293(97.7%), developed FGA medication induced side effects. One hundred sixty three (54.3%) participants were treated with Trihexyphenidyl for FGAs induced side effects. Dose reduction of antipsychotics was done for 51(17.0%) participants. Most of the participants' side effects were not managed according to American Psychiatric Association guideline; 178 (82.4%). The most common types of FGAs induced side effects were cardiovascular side effects 169(56.3%); sedation and CNS side effects 149(49.6%); and extrapyramidal side effects 114(38.0%). There is a significant association between occurrence of side effects of FGAs and duration of illness (P = 0.04). CONCLUSIONS: The prevalence of first generation antipsychotics induced side effects was high. However, management practice of the side effects was minimal.

The impact of the 2008 economic crisis on the increasing number of young psychiatric inpatients. / Impacto de la crisis económica del 2008 en el número de jóvenes hospitalizados por patología psiquiátrica.

BACKGROUND: Little is published about the impact of the 2008 economic crisis on mental health services in Spain. METHOD: An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. RESULTS: Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. CONCLUSIONS: Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes.

Louca América: a luta por uma América Latina sem manicômios / Mad America: the struggle for a Latin America without asylums

A tese versa sobre a constituição e trajetória do movimento antimanicomial na América Latina. Ao longo do século XX, esse movimento social se constituiu como sujeito coletivo que encampa a denúncia da violência e repressão que o manicômio representa. Estabeleceu formas de luta pela defesa, valorização e garantia dos direitos humanos e, de maneira mais ampla, a luta pela democracia. O movimento antimanicomial latino-americano representa também a loucura em sua forma criativa e política, pois integra o conjunto de movimentos sociais que se articulam em torno da construção de espaços de liberdade, cidadania e cuidado às pessoas em sofrimento mental. O objetivo da pesquisa que originou esta tese era analisar a relação entre as reformas psiquiátricas, políticas de saúde mental e os movimentos sociais no âmbito dos países da América Latina. A pesquisa, de cunho exploratório e ativista, foi realizada através de participação e observação nos protestos, marchas, reuniões e encontros, assim como em eventos nacionais e internacionais onde estiveram reunidos líderes e representantes do movimento político. Também foram realizadas entrevistas, além de conversas, com participantes do movimento no Brasil, Argentina, Uruguai e México. Foi realizada pesquisa no acervo histórico "Memórias da Reforma Psiquiátrica", assim como a leitura e análise de bibliografia e documentos que contribuíram para organização e reconstrução da trajetória do movimento antimanicomial latino-maericano. Como resultados, apresenta-se essa trajetória mostrando que os participantes e representantes desse movimento social conseguiram se organizar e se integrar por meio de eventos e encontros marcados pela diversidade e multiplicidade de manifestações em dois momentos históricos: pela Rede Latino-Americana de Alternativas à Psiquiatria na década de 1980; e pelos congressos internacionais de saúde mental e direitos humanos, realizados pela Universidade Popular das Madres de la Plaza de Mayo, de 2002 a 2013. Desde 2017, uma nova integração do movimento antimanicomial latino-americano vem sendo construída por meio da Rede Latino-Americana e Caribe de Direitos Humanos e Saúde Mental. Como crítica desse processo, discute-se a importância da multiplicidade e ancestralidade do movimento antimanicomial retomando seu caráter revolucionário, na medida em que integra à luta de classes. Apontam-se suas ambiguidades na forma da acomodação em torno dos processos de reforma que se faz por meio de uma visão reducionista e voluntarista da luta política. Finalmente, discutem-se seus limites mostrando como a reestruturação do Estado e das políticas públicas tem provido um deslocamento da acumulação do capital do manicômio para as drogas psiquiátricas, moldando um intenso processo de medicalização social que exige do movimento antimanicomial reflexão e estratégias de luta política. Para além desse primeiro e maior limite, o risco da fragmentação é apontado como um segundo limite a superar. A luta política em torno da loucura e seu destino social é uma dos embates sociais que se travam na América Latina constantemente e que se integra à luta internacional que se dirige à transformação e à superação do sistema capitalista. Analisar e participar do movimento antimanicomial é uma maneira de se integrar a luta por uma América Latina sem manicômios

The thesis deals with the constitution and trajectory of the anti-asylum movement in Latin America. Throughout the twentieth century, this social movement was constituted as a collective subject that provides the denunciation of the violence and repression that the asylum represents. It established forms of struggle for the defense, valorization and guarantee of human rights and, more broadly, the struggle for democracy. The Latin American anti-asylum movement also represents madness in its creative and political form, because it integrates the set of social movements that are articulated around the construction of spaces of freedom, citizenship and care for people in mental suffering. The objective of the research that originated this thesis was to analyze the relationship between psychiatric reforms, mental health policies and social movements within the countries of Latin America. The research, exploratory and activist, was carried out through participation and observation in protests, marches, meetings and meetings, as well as in national and international events where leaders and representatives of the political movement were gathered. Interviews and conversations were also held with participants from the movement in Brazil, Argentina, Uruguay and Mexico. A research was carried out in the historical collection "Memories of the Psychiatric Reform", as well as the reading and analysis of bibliography and documents that contributed to the organization and reconstruction of the trajectory of the Latin-American movement. As a result, this trajectory shows how the participants and representatives of this social movement managed to organize and integrate themselves through events and meetings marked by the diversity and multiplicity of manifestations in two historical moments: by the Latin American Network of Alternatives to Psychiatry in the 1980s; and the international congresses of mental health and human rights held by the Popular University of the Mothers of the Plaza de Mayo from 2002 to 2013. Since 2017, a new integration of the Latin American anti-manicomial movement has been built through the Latin American Network and the Caribbean on Human Rights and Mental Health. As a critique of this process, the importance of the multiplicity and ancestry of the anti-asylum movement is discussed, resuming its revolutionary character, insofar as it is part of the class struggle. They point out their ambiguities in the form of accommodation around the reform processes that is done through a reductionist and voluntarist vision of the political struggle. Finally, its limits are discussed, showing how the restructuring of the State and public policies has provided a shift from the accumulation of the capital of the asylum to psychiatric drugs, shaping an intense process of social medicalization that demands of the antimanicomial movement reflection and strategies of political struggle . Beyond this first and largest limit, the risk of fragmentation is set as a second limit to be overcome. The political struggle over madness and its social destiny is one of the social struggles that are constantly being tackled in Latin America, and which is part of the international struggle for transformation and overcoming of the capitalist system, its crises and contradictions. Analyzing, integrating and participating in the anti-asylum movement is a way to integrate into this struggle for a Latin America without asylums

Ecological assessment of daily suicidal thoughts and attempts among suicidal teens after psychiatric hospitalization: Lessons about feasibility and acceptability.

Despite its potential to yield information about the dynamic course of suicidal ideation/behavior in individuals' natural environment, Ecological Momentary Assessment (EMA) has been strikingly underutilized among suicidal teens. This study reports on feasibility and acceptability of ecological assessment of daily suicide risk-related outcomes ("daily diaries," a special case of EMA) among adolescent inpatients in the critical post-discharge period. Thirty-four adolescents (76% female; ages 13-17) responded to daily electronic surveys for four weeks after discharge. Survey adherence was 69% (n = 650 days) and decreased each week. Adherence was half as likely among adolescents without attempt history (OR = 0.50, CI = 0.27-0.95). Mid- and end-point study responses indicated high acceptability of daily diaries. Most adolescents reported no change or more positive change in their thoughts/mood after daily surveys. Suicidal ideation was reported on 24.4% (n = 159) of the days. In the month post discharge, more teens reported suicidal thoughts using daily surveys (70.6%) compared to end-of-study assessment (45.2%) (Chi-square = 4.24, p = .039). Two participants (5.9%) reported an attempt. Ideation frequency and duration varied across time, suggesting utility of frequent assessments in this context. EMA data collection with high-risk adolescents offers a feasible approach to examining real-time suicidal ideation/behavior, yielding nuanced information that is critical to advancing suicide prevention efforts.

Increasing the Continuity of Care between Primary Care Provider and a Psychiatric Hospital in Singapore.

INTRODUCTION: People who have a mental illness and who are stable on their current treatment may be suitable for follow-up care with a community-based general practitioner. A general practitioner-partnership programme was designed in an institute in Singapore to facilitate the transition to community services. However, the rates of successful referrals were low. METHODS: Our study followed the format of a quality improvement project, and used administrative data from April 2014 to June 2016 to gauge the impact of the interventions chosen to improve uptake of referrals. Three potential areas of improvement were found based on interviews with 25 service users. RESULTS: During the 11 months of pre-intervention period (April 2014 to February 2015), 64% of potentially suitable service users (152 of 238 referrals) transitioned to community services. Low transition was linked to 3 identified causes and consequently, case managers developed personalised financial counselling for service users, assisted in the application for financial supports, and dispelled misconceptions about service provider inability to treat mental illness. Over the 16 months of intervention period (March 2015 to June 2016), the follow-up rate for referrals rose to 92% (260 / 283 referrals). CONCLUSION: Given that financial support entitlements change, it is important for case managers to remain aware of changing policy. Misconceptions of service provider qualifications may have a great impact on service user's willingness to seek services from primary care providers.

[Limitations of Routine Assessment and Presentation of Trends of Patient Assaults in Psychiatric Hospitals]. / Limitationen der Routineerfassung und Trenddarstellung von Gewaltereignissen in psychiatrischen Kliniken.

Objective Contribution to the analysis of patient assault routine data from psychiatric wards over a period of 10 years. Methods A recently published time series of violent incidents reported an increase over 8 years. The entire series including subsequent 1.5 years is re-analyzed regarding influencing factors and trend lines. Results The number of incidents fluctuates at a low level. A non-linear trend appears appropriate. Conclusions Assessment of routine data is important, should be standardized and consider influences and limitations.

Anticholinergic use trends in 14,013 patients with schizophrenia from three national surveys on the use of psychotropic medications in China (2002-2012).

Our previous study demonstrated that there have been changes in the patterns of prescription antipsychotic use in China over the period from 2002 to 2012. The aim of this study was to evaluate whether time trends were present for the prescription of anticholinergic medications (ACMs) during the observation period. A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were surveyed in 2002, 2006 and 2012. Basic socio-demographic and clinical characteristics and the prescription of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The frequency of ACM prescription was 25.9% in the whole sample (29.5%, 21.6%, and 27.4% in 2002, 2006 and 2012, respectively). In addition, different temporal trends were observed across age groups. Multiple logistic regression analysis of the entire sample showed that ACM prescriptions were predicted by females, outpatients, patients receiving high doses of antipsychotic medication, select study years, benzodiazepine users, patients displaying extrapyramidal side effects, as well as antipsychotic prescription patterns. Although there was more widespread use of second-generation antipsychotics over the past decade, the frequency of ACM use only slightly decreased. How to use ACM appropriately is still a therapeutic issue that needs to foster evidence-based prescription practice.

Estimating the prevalence of depression associated with healthcare use in France using administrative databases.

BACKGROUND: Quantitative indicators are needed in order to define priorities, plan policies and evaluate public health interventions in mental health. The aim of this study was to assess the contribution of a large and exhaustive French national administrative database to study and monitor treated depression by comparing the prevalence and characteristics of the population using significant healthcare resources for depression as identified by different estimation methods and sources and to discuss the advantages and drawbacks of these methods. METHODS: This study included the French population covered by the main health insurance scheme in 2012 (Régime général, 86% of the insured French population). Data were extracted from the French health insurance claim database (SNIIRAM), which contains information on all reimbursements, including treatments and hospital stays in France. The following distinct sources of the SNIIRAM were used to select persons with depression: diagnoses of long-term or costly conditions, data from national hospital claims and data concerning all national health insurance reimbursements for drugs. RESULTS: In 2012, we included 58,753,200 individuals covered by the main health insurance scheme; 271,275 individuals had full coverage for depression; 179,470 individuals had been admitted to a psychiatric hospital and 66,595 individuals admitted to a general hospital with a diagnosis of depression during a 2-year timeframe and 144,670 individuals had more than three reimbursements for antidepressants during the study year (with a history of hospitalisation for depression during the past 5 years). Only 16% of individuals were selected by more than one source. CONCLUSIONS: We propose an algorithm that includes persons recently hospitalised for depression, or with a history of hospitalisation for depression and still taking antidepressants, or with full coverage for depression as a specific long-term or costly condition, yielding a prevalence estimate of 0.93% or 544,105 individuals. Changes in the case selection methodology have major consequences on the frequency count and characteristics of the selected population, and consequently on the conclusions that can be drawn from the data, emphasizing the importance of defining the characteristics of the target population before the study in order to produce relevant results.

[Psychiatric and psychosomatic day hospitals in Austria]. / Psychiatrische und psychosomatische Tageskliniken in Österreich.

This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.

Out of sight, out of mind.

As a result of the psychiatric hospital closure programme the use of private sector facilities for those needing longer-term care and support has increased. However, local rehabilitation services may be a better solution than out of area treatment.

[Compulsory admission to hospital in Tunisia: a necessary evolution]. / Hospitalisation sans consentement en Tunisie : une évolution nécessaire.

The evolution of the legislation governing compulsory admission to hospital in Tunisia is interesting for two reasons. The country's 2011 revolution notably brought about major changes to the legislative framework, from constitutional through to ordinary laws. At the same time, the current trend for globalisation is also affecting legislation: international laws, treaties and UN charters are imposed on the laws of individual countries. This article looks at how Tunisian law governing compulsory admission to hospital has had to evolve.

[Steps toward an integrated and collaborative health care system for the community life of patients with dementia].

In 2012, the Ministry of Health, Labour and Welfare published a report, entitled: "Direction of Policies on Dementia" (hereinafter referred to as Direction), and announced a "Five-Year Plan for the Promotion of Measures against Dementia (Orange Plan)". I first overviewed the issues with Direction. Direction aims to develop a standard dementia care pathway by establishing the coordination of agencies for patients with dementia and improve long-term care services to support the community life of patients with dementia. However, several objectives proposed in Direction appear to lack scientific grounds, and it is uncertain if they are feasible. In addition, fragmentation remains in the proposed dementia health care pathway. Health care services provided by psychiatric hospitals are undervalued in the proposed pathway. Inpatient and outpatient medical care for patients with dementia should be integrated in the dementia care pathway and complementary to long-term care services to achieve the smooth and safe transition of a patient from the hospital to their home (and from their home to the hospital) and support the daily lives of community-dwelling patients with dementia and their care givers. The wards in psychiatric hospitals need to be more specialized, in order to be able to contribute to comprehensive community care. I discussed functions of psychiatric hospitals and how a dementia ward can be specialized depending on the functions it should serve.

Mental health inpatient treatment expenditure trends in China, 2005-2012: evidence from Shandong.

BACKGROUND: Mental health is increasingly becoming a huge public health issue in China. Yet for various cultural, healthcare system, and social economic reasons, people with mental health need have long been under-served in China. In order to inform the current on-going health care reform, empirical evidences on the economic burden of mental illnesses in China are urgently needed to contribute to health policy makers' understanding of the potential benefits to society from allocating more resources to preventing and treating mental illness. However, the cost of mental illnesses and particularly its trend in China remains largely unknown. AIMS OF THE STUDY: To investigate the trend of health care resource utilization among inpatients with mental illnesses in China, and to analyze what are the factors influencing the inpatient costs. METHOD: Our study sample included 15,721 patients, both adults and children, who were hospitalized over an eight-year period (2005-2012) in Shandong Center for Mental Health (SCMH), the only provincial psychiatric hospital in Shandong province, China. Data were extracted from the Health Information System (HIS) at SCMH, with detailed and itemized cost data on all inpatient expenses incurred during hospitalization. The identification of the patients was based on the ICD-10 diagnoses recorded in the HIS. Descriptive analysis was done to analyze the trend of hospitalization cost and length of stay during the study period. Multivariate stepwise regression analysis was conducted to assess the factors that influence hospitalization cost. RESULTS: Among the inpatients in our sample, the most common mental disorders were schizophrenia, schizotypal and delusional disorders. The disease which had the highest per capita hospital expense was behavioral and emotional disorders with onset usually occurring in childhood and adolescence (RMB 8,828.4; US$ 1,419.4, as compared to the average reported household annual income of US$ 2,095.3 in China). The average annual growth rate of per capita hospitalization cost was 23.6%, with the inpatient cost reaching RMB 11,949 (US$ 1921.1) in 2012. The hospitalization cost was found to be strongly associated with hospital length of stay, level of care, age, employment status, admission diagnoses, and frequency of hospitalization. DISCUSSION: Our study found that mental health inpatient resources use, particularly hospitalization cost, has been growing at an increasing rate. In our sample, hospitalization cost nearly tripled from 2005 to 2012. Mental illnesses and the related economic burden on the population will continue to grow, making mental health a major public health issue in China. Hospital length of stay was found to be increasing in our sample, and positively correlated with hospitalization cost. Childhood and adolescence behavioral and emotional disorders were found to be significantly associated with higher inpatient cost. IMPLICATIONS FOR HEALTH POLICIES AND FUTURE RESEARCH: The policy implications generated from the results of this study are two-fold: first of all, in order to meet the growing need of mental health care in China, the government needs to significantly increase its spending in preventing and treating mental illnesses. Second, cost containment in inpatient care would become a major challenge for mental health policy makers in China. Government support, clinical practices and guideline development, as well as research are urgently needed to promote mental health prevention and improve the efficiency of mental health system in China. The current mental health system, like the overall healthcare system in China, relies heavily on hospital inpatient care. In order to build a sustainable mental health care system to meet increasing population need in China, it is crucial to integrate mental health care reform with the ongoing primary health care reform. Future mental health policy reform and research in China should put more focus on how to strengthen primary care system as well as community support, establish effective two-tier referring mechanism between hospital and primary care system, and to ensure continuity of care.