Development and implementation of a psychotherapy tracking database in primary care.

INTRODUCTION: Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. METHOD: A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. RESULTS: Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. DISCUSSION: The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record

[Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city]. / Arte, saúde mental e atenção pública: traços de uma cultura de cuidado na história da cidade de São Paulo.

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

Holistic approach to community in crisis.

This report emphasizes the belief that whatever the type and scale of disaster, the period of transition from relief to recovery is the most critical. Following the severe earthquake that struck Kachchh, Gurjarat, India on 26 January 2001, emotions spanned grief over the lives lost; anxiety over property and other economic losses; profound feelings of isolation, helplessness, and guilt; and panic in the face of problematic communications from authorities. In an attempt to manage this vast array of psychosocial problems, a large cadre of volunteers was rapidly trained and supervised by experts to work as grass-roots counselors for the community.

Transforming assertive community treatment into an integrated care system: the role of nursing and primary care partnerships.

Despite the high rate of co-occurring medical conditions experienced by individuals receiving assertive community treatment (ACT), this comprehensive service model continues to be considered primarily a mental health intervention. Without compromising fidelity to the model, ACT can serve as an ideal platform from which to provide both primary and behavioral health care to those with complex service needs. Using a case example, this article considers the transformation of the ACT mental health care model into an integrated health care delivery system through establishing nursing and primary care partnerships. Specifically, by expanding and explicitly redefining the role of the ACT nurse, well-developed care models, such as Guided Care, can provide additional guidelines and training to ACT nurses who are uniquely trained and oriented to serve as the leader and coordinator of health integration efforts.

The future of community-centred health services in Australia: lessons from the mental health sector.

It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends are explored. The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such community-centred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services

The place and promotion of well-being in mental health services: a qualitative investigation.

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.

[Mental health care in Austria: history--developments--perspectives]. / Psychiatrische Versorgung in Osterreich: Rückblick - Entwicklungen - Ausblick.

The reform of psychiatric services in Austria started during the second half of the seventies of the 20th century. During the early phase the reform focussed on dehospitalization and principles of community psychiatry. About 60% of psychiatric hospital beds were closed and the size of psychiatric hospitals was reduced. One of the psychiatric hospitals was closed and psychiatric departments were opened as part of district general hospitals. During this time the number of psychiatric hospital admissions increased markedly and a large proportion of mentally ill are treated as inpatients in non-psychiatric wards. Only about a fifth of self-employed psychiatrists working in their own office have a contract with health insurances. In Austria, the number of psychotherapists is much higher than the number of psychiatrist. A variety of different types of community services provide social and vocational rehabilitation, focussing on consultation, housing, daily structure and employment. Psychiatric services are nowadays fragmented into a number of sub-disciplines such as psychosomatics or child and adolescent psychiatry. This fragmentation and the missing coordination of psychiatric services hamper the enhancements of psychiatric care. This complicates the development of integrated services, i.e. the structured and planned cooperation of the different types of services. Since there are no binding rules for the organisation and planning in entire Austria, financing and organisation of services is fragmented. For establishing an integrated health care, coordination and cooperation between providers, sponsors of health care as well as policy makers are essential.

Mental health services then and now.

Over the past twenty-five years, psychiatric services have shifted from hospital to community. Managed care reinforces this trend. Mental illness is better understood and less stigmatized, and services are more commonly used. But many in need do not receive care consistent with evidence-based standards, or at all. Challenges are greatest for people with serious and persistent mental illnesses who depend on generic health and welfare programs and integrated services. Evidence-based rehabilitative care is often unavailable. Failures in community care lead to arrest; jail diversion and treatment are required. Despite progress, implementing an effective, patient-centered care system remains a formidable challenge.

Transforming mental health care for children and their families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed.

[Implementation of integrated mental health care in an urban district of Tokyo].

Japan had a long history of long-term hospital care and is now trying to change it into community-based psychiatry. Implementing comprehensive approach that has already been proven effective through evidence based data in one particular community, one has to overcome several local barriers, if the same approach is to be implemented in different situations, such as differences in socio-cultural background and health care system. This is a report of the activities of Minato Net 21 pointing out the "local barriers" on implementing comprehensive approach in an urban district of Tokyo.

The future of community psychiatry.

Leaders of national groups that have focused on issues of community and social psychiatry present their ideas about the future of psychiatry. They identify five areas: theory development; the relevance of community psychiatry in the 21st century; education and training; the relationship between community psychiatry and health maintenance organizations; and role of community psychiatry in bridging medical science with humanism. The unifying theme for these topics is that community psychiatry can be a vehicle for modifying general psychiatry's propensity towards individualism and reductionism by offering a more holistic and integrative approach to illness and well-being.

Mental health reform and evolution of general psychiatry in Ontario.

OBJECTIVES: To discuss developments in Ontario mental health reform, describe general psychiatric services in contrast to tertiary services, describe guidelines for the training of general psychiatrists, and suggest what changes may be required to develop an integrated mental health system (IMHS). METHOD: We review the Ontario government's recent blueprint for mental health reform and the Canadian federal government's document on best practices in psychiatry, in the context of defining general psychiatric services and their relation to tertiary services. From this, we consider the education of general psychiatrists and make suggestions for their training. RESULTS: General psychiatric services correspond to first-line and intensive psychiatric services delivered by community mental health agencies, community psychiatrists, and general hospitals for patients with moderate or serious mental illness. Many suggest that psychiatrists are not being trained to meet the needs of a reformed mental health system. An education program for general psychiatrists should include training in a wide range of community and general hospital settings, work within a multidisciplinary mental health team, and experience working in a shared care model with family physicians. CONCLUSIONS: Along with training general psychiatrists better, we must also develop recruitment and payment incentives, which would allow general psychiatrists who are based in the community and general hospitals to work within an IMHS.

[Off-site and alternative services in community mental health care in Quebec]. / L'ailleurs et l'autrement des pratiques communautaires en santé mentale au Québec.

The objective of this article is to understand the evolution of the practice of "elsewhere" and "otherwise" that alternative community resources in Québec have consistently advocated. Towards this end, we begin by identifying the meaning and significance of the ideas of "elsewhere" and "otherwise" in the context of the transformation of Quebec's mental health system since 1989. Then we present the results of an exploratory study carried out between 1997 and 1999 in which the coordinators as well as members of 6 community mental health organisations in a semi-urban region of Quebec were interviewed. The results of the study suggest the validity of certain fears that community resources are becoming "deradicalized." The analysis presented here suggests the unfolding of a complex process involving the integration of alternative resources into the broader public mental health system, internal dynamics, and the emerging limitations of the vision of "elsewhere" and "otherwise" that has guided them until now. Twenty years after alternative community resources appeared on the Quebec mental health scene, is it time to reform the philosophy of "elsewhere" and "otherwise"?

[The situation in integrated and community-oriented psychiatric treatment institutions with new financial realities]. / Sytuacja zintegrowanej i zorientowanej srodowiskowo jednostki lecznictwa psychiatrycznego w nowych realiach finansowania.

The author describes the structure and functioning of a psychiatric treatment institution which is integrated and community-oriented. He discusses subsequently its readiness to implement changes and goes through adaptation actions (which have taken place at the cost of stuff and quality and extent of service). The situation after four months of financing by health-care funds has been analysed. Finally, the author presents his remarks regarding the on going changes, concerns for the future and suggests new solutions (e.g., capitalized way of financing psychiatric treatment institutions).