The benefits and harms of community treatment orders for people diagnosed with psychiatric illnesses: A rapid umbrella review of systematic reviews and meta-analyses.

AIMS: Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. METHODS: A systematic search of Medline, PubMed, Embase and PsycINFO for relevant systematic reviews and/or meta-analyses. Where available, participants on community treatment orders were compared with controls receiving voluntary psychiatric treatment. This review is registered with PROSPERO (CRD42023398767) and the Open Science Framework (https://osf.io/zeq35). RESULTS: In all, 17 publications from 14 studies met the inclusion criteria. Quantitative synthesis of data from different systematic reviews was not possible. There were mixed findings on the effects of community treatment orders on health service use, and clinical, psychosocial or forensic outcomes. Whereas uncontrolled evidence suggested benefits, results were more equivocal from controlled studies and randomised controlled trials showed no effect. Any changes in health service use took several years to become apparent. There was evidence that better targeting of community treatment order use led to improved outcomes. Although there were other benefits, such as in mortality, findings were mostly rated as suggestive using predetermined and standardised criteria. Qualitative findings suggested that family members and clinicians were generally positive about the effect of community treatment orders but those subjected to them were more ambivalent. Any possible harms were under-researched, particularly in quantitative designs. CONCLUSIONS: The evidence for the benefits of community treatment orders remains inconclusive. At the very least, use should be better targeted to people most likely to benefit. More quantitative research on harms is indicated.

Helping Practitioners Stop, Drop, and Roll: Suggestions to Help Improve Responses to Intense Clinical Events.

Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners' emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This "hot-cold state empathy gap" is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners' ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.

Satisfaction with mental health community services among patients' relatives / Satisfação com serviços comunitários de saúde mental entre os familiares dos pacientes

ABSTRACT: Objective: This study aims to assess the satisfaction of family members of patients of mental health community services through a tested, validated and previously applied scale in order to allow comparison of results. Methods: The results were obtained by applying the scale SATIS-BR to 1242 relatives of patients of 40 mental health community services in Brazil. The average scores of the three subscales of the SATIS-BR scale were compared using the Wilcoxon test. To measure statistical significance for each item of the scale, the Friedman test was applied, considering significant p-value < 0.05. Results: The average overall satisfaction score was 4.35 with a standard deviation (SD) of 0.44, with a range varying from 1 to 5. The subscale with the highest score refers to the "Results of Treatment", what presents scores of 4.54 with SD of 0.66. As for the other subscales, which refer to "Reception and Staff Competence" and "Service Privacy and Confidentiality" had scores of 4.25 (SD: 0.51) and 4.17 (SD: 0.51). Conclusion: The high level of satisfaction with the service among families of patients highlights the potential of these services and their contribution to the advance of a model of mental health community care, as it seems to be the global trend. The different results between the scales further suggest that the family distinguishes different aspects of the service and evaluates separately, providing a good reference for evaluation studies.

RESUMO: Objetivo: Este estudo objetivou avaliar a satisfação dos familiares de pacientes de serviços comunitários de saúde mental através de uma escala testada, validada e aplicada anteriormente, a fim de permitir a comparação de resultados. Métodos: Os resultados foram obtidos através da aplicação da escala SATIS-BR em 1242 familiares de pacientes de 40 serviços comunitários de saúde mental no Brasil. Os escores médios das três subescalas da escala SATIS-BR foram comparados pelo teste de Wilcoxon. Para medir a significância estatística para cada item da escala, o teste de Friedman foi aplicado, considerando-se como significância valor de p < 0,05. Resultados: A pontuação satisfação global média foi de 4,35, com desvio padrão (DP) de 0,44, em uma escala que varia de 1 a 5. A subescala com maior pontuação se refere aos "Resultados do Tratamento", que apresentou escore de 4,54 com DP de 0,66 . Quanto as outras subescalas, que se referem a "Recepção e Competência da Equipe" e "Privacidade e Confidencialidade do Serviço" as pontuações foram de 4,25 (DP: 0,51) e 4,17 (DP: 0,51) respectivamente. Conclusão: O elevado nível de satisfação com o serviço entre os familiares dos pacientes destaca o potencial desses serviços e a sua contribuição para o avanço de um modelo comunitário de atenção à saúde mental. Os resultados diferentes entre as escalas sugerem ainda que o familiar distingue os diversos aspectos do serviço e os avalia separadamente, constituindo uma boa referência para estudos de avaliação.

Fatores associados à percepção de melhora por usuários de Centros de Atenção Psicossocial do Sul do Brasil / Factors associated with perception of improvement by users of Centers for Psychosocial Care in the South of Brazil / Factores asociados a la percepción de mejora por parte de usuarios de Centros de Atención Psicosocial del sur de Brasil

Este estudo objetivou investigar os fatores associados à melhora percebida pelos usuários de Centros de Atenção Psicossocial (CAPS). Estudo transversal, realizado com 1.493 usuários de CAPS do Sul do Brasil. A melhora percebida pelos participantes foi avaliada pela Escala de Mudança Percebida - Pacientes (EMP-Pacientes). Para investigação dos fatores associados, muniu-se de uma regressão logística guiada por um modelo hierárquico que considerou como associação um valor de p < 0,05. Os fatores associados ao desfecho foram: estado de alocação do CAPS, possuir trabalho remunerado, diagnóstico de esquizofrenia, menor idade quando diagnosticado, maior tempo de frequência no serviço, facilidade de acesso e envolvimento na avaliação. Entre os fatores que efetivamente tencionam melhora nos usuários, destacam-se aqueles referentes às características da doença e os aspectos relativos aos serviços quanto à execução das políticas de saúde mental e quanto à organização deles.

This study aimed to investigate factors associated with perceived improvement among users of Centers for Psychosocial Care. This was a cross-sectional study of 1,493 users of Centers for Psychosocial Care in the South of Brazil. Users' perceived improvement was assessed by Perceived Change Scale - Patients (PCS-Patients). Associated factors were investigated using logistic regression guided by a hierarchical model, with statistical significance set at p < 0.05. Factors associated with the outcome were: state where the Center for Psychosocial Care was located, paid work, diagnosis of schizophrenia, age at diagnosis < 18 years, longer time attending the center, ease of access, and involvement in the evaluation. The factors that actually involve improvement in users include those pertaining to characteristics of the illness and aspects related to services in the implementation of mental health policies and their organization.

Este estudio tuvo como objetivo investigar los factores asociados a la mejora percibida por los usuarios de Centros de Atención Psicosocial. Estudio transversal, realizado con 1.493 usuarios de Centros de Atención Psicosocial del sur de Brasil. La mejora percibida por los participantes se evaluó mediante la Escala de Cambios Percibidos - Pacientes (EMP-Pacientes, por sus siglas en portugués). Para la investigación de los factores asociados, se hizo uso de una regresión logística guiada por un modelo jerárquico que consideró como asociación un valor de p < 0,05. Los factores asociados al desenlace fueron: estado de asignación del Centro de Atención Psicosocial, tener trabajo remunerado, diagnóstico de esquizofrenia, menor de edad cuando se es diagnosticado, mayor tiempo de frecuencia en el servicio, facilidad de acceso y participación en la evaluación. Entre los factores que efectivamente prevén mejora en los usuarios, se destacan aquellos referentes a las características de la enfermedad y los aspectos relativos a los servicios, en cuanto a la ejecución de las políticas de salud mental y respecto a la organización de los mismos.

Propuesta para abordar los problemas de salud mental detectados en el proceso diagnóstico de la Delegación Presidencial para la reconstrucción tras el terremoto del 27 de febrero de 2010 / Proposal to address the mental health problems detected after the February 27, 2010 earthquake

One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress.

A enfermagem e o cuidar na área de saúde mental: [revisão] / Nursing and caring for in the area of mental health: [revision] / La Enfermería en el cuidar en el área de la salud mental: [revisión]

Este trabalho descreve os aspectos político-sociais que envolveram a reforma da assistência psiquiátrica, enfocando o processo de desinstitucionalização e a importância da enfermagem além de constituinte da equipe interdisciplinar. Objetiva analisar o processo de assistência de enfermagem ao doente mental em serviços externos ao hospital. Constitui-se de revisão bibliográfica em periódicos nacionais no período de 1999 a 2001. As autoras discutem sobre o comprometimento dos trabalhadores na área de saúde mental, com a "desconstrução"/construção a cerca do cuidado, fazendo-se necessária uma abordagem humanizada por meio do relacionamento interpessoal de pacientes, enfermeiros e as equipes responsáveis pela assistência ao doente mental.

This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss workers' engagement in the area of mental health, with the "deconstruction"/construction about care, making necessary a humanized approach by way of the interpersonal relationship of patients, nurses and the teams responsible for giving assistance to the mentally sick.

Este trabajo describe los aspectos político-sociales que involucraron la reforma de la asistencia psiquiátrica, enfocando el proceso de desinstitucionalización y la importancia de la enfermería además de constituyente del equipo interdisciplinar. Objetiva analizar el proceso de asistencia de enfermería al enfermo mental en servicios externos al hospital. Se constituye de revisión bibliográfica en periódicos nacionales en el período de 1999 a 2001. Las autoras discuten sobre el compromiso de los trabajadores en el área de salud mental, con la "desconstrucción"/construcción acerca del cuidado, haciéndose necesario un abordaje humanizado por medio de la relación interpersonal de pacientes, enfermeros y los equipos responsables por la asistencia al enfermo mental.

Outcome of first contact schizophrenia in Jamaica

Several previous studies have identified high incidence rates, high relapse rates and poor short-term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62) were treated at home, and 120 (38) were admitted to hospital for treatment. Two hundred and sixty-four (83) were still being seen after one year. The relapse rate was 13 (41 patients), higher for admissions (24, 20) than for those treated at home (17, 9; p < 0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p < 0.005). One hundred and thirty-five (43) were in gainful employment within the 12-month period of follow-up, contrasted with the 40 unemployment rate for the 2.4 million population of the island (chi square = 39.322, p < 0.001). There was a self-reported use of medication in 213 (67) patients, with 142 (45) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first service contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short-term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK.