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1.
Epidemiol Psychiatr Sci ; 29: e104, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32089149

RESUMEN

Person-centred care is at the core of a value-based health system. Its transformative potential is to enable and support key policy, planning and service developments across the system even when these go against the self-interest of individual major players. It offers a potent test for decision makers at all levels. It demands responses that are multi-level, empirically grounded, expert-informed and data-driven that must converge on the singularity of individuals in the places that they live. This requires different approaches that recognise, respect and reconcile two necessary but constitutionally disparate perspectives: the bureaucratic, overtly decontextualised, top-down, policy and planning objectives of central governments and the formally complex, dynamic and contextualised experience of individuals in the system. Conflating the latter with the former can lead unwittingly to a pervasive and reductive form of quasi-Taylorism that nearly always creates waste at the expense of value. This has parallel application in the treatment domain where outcomes are non-randomly clustered and partitioned by socioeconomic status, amplifying unwarranted variation by place that is striking in its magnitude and heterogeneity. In this paper, we propose that a combination of (1) relevant, local and sophisticated data planning, collection and analysis systems, (2) more detailed person-centred service planning and delivery and (3) system accountability through co-design and transparent public reporting of health system performance in a manner that is understandable, relevant, and locally applicable are all essential in ensuring planned and provided care is most appropriate to more than merely the 'average' person for whom the current system is built. We argue that only through a greater appreciation of healthcare as a complex adaptive (eco)system, where context is everything, and then utilising planning, analysis and management methodologies that reflect this reality is the way to achieve genuine person-centred care.


Asunto(s)
Servicios de Salud Mental/organización & administración , Atención Dirigida al Paciente , Calidad de la Atención de Salud , Adolescente , Prestación de Atención de Salud , Investigación sobre Servicios de Salud , Humanos , Trastornos Mentales/terapia
2.
Epidemiol Psychiatr Sci ; 29: e100, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-32000876

RESUMEN

There are tens of thousands of mental health-related apps available today - representing extreme duplication in this digital age. Instead of a plethora of apps, there is a need for a few that meet the needs of many. Focusing on transparency and free sharing of software, we argue that a collaborative approach towards apps can advance care through creating customisable and future proofed digital tools that allow all stakeholders to engage in their design and use.


Asunto(s)
Servicios de Salud Mental/organización & administración , Salud Mental , Aplicaciones Móviles , Telemedicina/métodos , Tecnología Biomédica , Humanos , Trastornos Mentales/terapia , Programas Informáticos
3.
Epidemiol Psychiatr Sci ; 29: e101, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32029018

RESUMEN

Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries (LMICs), and using exemplars from the front-lines in South Africa; we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. While this approach will promote systems more enabling of scaling up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.


Asunto(s)
Salud Global , Política de Salud , Servicios de Salud Mental/organización & administración , Salud Mental , Prestación Integrada de Atención de Salud , Países en Desarrollo , Humanos , Calidad de la Atención de Salud , Sudáfrica
4.
Epidemiol Psychiatr Sci ; 29: e87, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31915090

RESUMEN

Increasing numbers of young adults need continued support for their attention deficit hyperactivity disorder (ADHD) beyond the age-boundary for children's services. The sparse literature on transition in general suggests patchy provision and huge gaps in transitional care, but also that young people with ADHD and other neurodevelopmental disorders fair particularly badly. Transition in health care coincides with many other important life-transitions while the difficulties associated with ADHD may make these challenges particularly hard to cope with. Parents or other advocates therefore often need to be involved, which can present problems in adult mental health services given that they tend to be less family oriented than children's services. Importantly, young people need help negotiating the transition from passive recipient of care to active self-management, and in building relationships with the adult team.In addition to patchy provision of adult ADHD services, transition is currently hampered by poor understanding of ADHD as a long term condition and uncertain knowledge of what services are available among young people and parents as well as the clinicians working with them. Guidelines recommend, and more importantly young people want, access to psycho-social interventions as well as medication. However, available evidence suggests poor quality transitional care and adult services that are highly focused on medication.Adult ADHD services need to undergo similar development to that experienced by Child and Adolescent Mental Health Services and community paediatrics over the last few decades. While we debate the relative merits of dedicated or specialist v. generic adult mental health services, for young adults with ADHD the training, experience and availability of professionals are more important than their qualifications or setting.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental/organización & administración , Transición a la Atención de Adultos , Adolescente , Niño , Progresión de la Enfermedad , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Cuidado de Transición , Adulto Joven
6.
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31343744

RESUMEN

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Prisioneros/psicología , Prisiones , Adulto , Coinfección , Femenino , Infecciones por VIH/epidemiología , Hepatitis C Crónica/epidemiología , Humanos , Estudios Longitudinales , Masculino , Polifarmacia , Estudios Prospectivos , Psicotrópicos/uso terapéutico , España/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
7.
Lancet Psychiatry ; 7(1): 78-92, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31474568

RESUMEN

Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.


Asunto(s)
Prestación Integrada de Atención de Salud , Planificación en Salud , Trastornos Mentales , Servicios de Salud Mental , Atención Primaria de Salud , Adulto , Países en Desarrollo , Accesibilidad a los Servicios de Salud , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , Pobreza
8.
J Forensic Nurs ; 16(1): 47-54, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31834077

RESUMEN

INTRODUCTION: Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients. METHODS: An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis. FINDINGS: Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation. DISCUSSION: Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.


Asunto(s)
Actitud del Personal de Salud , Servicios de Salud Mental/organización & administración , Internación Compulsoria del Enfermo Mental , Continuidad de la Atención al Paciente/organización & administración , Femenino , Humanos , Entrevistas como Asunto , Servicios de Salud Mental/legislación & jurisprudencia , Zimbabwe
10.
Mayo Clin Proc ; 94(12): 2510-2523, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31806104

RESUMEN

Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.


Asunto(s)
Servicios de Salud Mental/organización & administración , Telemedicina/organización & administración , Humanos , Videoconferencia
11.
Br J Nurs ; 28(19): 1251-1255, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31680575

RESUMEN

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.


Asunto(s)
Trastornos de la Memoria/enfermería , Servicios de Salud Mental/organización & administración , Enfermeras Practicantes , Rol de la Enfermera , Inglaterra , Humanos , Medicina Estatal/organización & administración
13.
N C Med J ; 80(6): 356-362, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31685571

RESUMEN

There has been a dramatic increase in the number of individuals incarcerated in the United States during the past several decades. Providing behavioral health care services to incarcerated people within North Carolina's prison system presents several challenges, and progress is being made to deliver care that is consistent with accepted community standards.


Asunto(s)
Servicios de Salud Mental/organización & administración , Prisiones/organización & administración , Humanos , Trastornos Mentales/terapia , North Carolina , Prisioneros/psicología
15.
Psychiatr Hung ; 34(4): 380-392, 2019.
Artículo en Húngaro | MEDLINE | ID: mdl-31767798

RESUMEN

The provision and coordination of good quality care in mental health represents a major challenge worldwide. The direct and indirect costs of psychiatric disorders, including costs due to substance use disorders are very high in the countries of the European Union. The prevalence of both mental disorders and substance use disorders is significant in Hungary. Leaders of the psychiatric profession joined forces and assembled a complex plan for the development of mental health care in Hungary. The National Programme of Mental Health represents both challenges and opportunities for this area. The main objective is a stepped care and collaborative care model for individuals with psychiatric disorders that incorporates the primary care system (general practitioners) and the community psychiatry providers. Primary care needs to develop competence to identify and treat people with common mental disorders, supported by a new care model of clinical psychologist counseling services. The tasks of these psychologists include screening (assessment interviews), giving information, leading patients to the optimal therapeutic pathways, psychoeducation and low-intensity psychological interventions. The psychologist represents a bridge between the family doctor and psychiatric care. The programme aims to shift mental health services from hospitals to community mental health facilities services. However there is a parallel organization of health and social care systems in Hungary that inhibits the complex care of patients. It is necessary to develop a closer coordination (or collaboration) of out-patient psychiatric care and the community-based services, to provide more and better facilities for reintegration of patients. Continuity of care can beestablished by psychiatrists being responsible for treatment plans and pathways, including the frequency of follow-up visits or the need for transferring patients to family doctors or to psychiatric hospitals. In some areas there is an important need for the development of specialized teams or units (for example crisis intervention service, forensic psychiatric unit, mother-child unit, psychiatric emergency rooms, high security wards). Human resources represent a major problem, the numbers of psychiatric nurses and psychiatrists are insufficient. The dysfunctional distribution of human resources leads to the deterioration of services. This is principally financial question. In the future the psychiatry should take advantage of the possibilities offered by digital technology. In this paper we present the main elements of the National Programme of Mental Health. We hope that the programme can be realized in the coming years with financial support of the Hungarian Government.


Asunto(s)
Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/tendencias , Salud Mental , Humanos , Hungría , Trastornos Mentales/terapia , Psiquiatría/organización & administración , Psiquiatría/tendencias
17.
BMC Health Serv Res ; 19(1): 878, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752869

RESUMEN

BACKGROUND: Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve. METHODS: A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation. RESULTS: Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily. CONCLUSION: The CHW's are "dedicated" mental health workers as opposed to being "generalists" and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Salud Mental/organización & administración , Estudios de Tiempo y Movimiento , Visita Domiciliaria/estadística & datos numéricos , Humanos , India , Servicios de Salud Rural/organización & administración , Flujo de Trabajo
18.
Artículo en Inglés | MEDLINE | ID: mdl-31635045

RESUMEN

Women's partners may act as facilitators of professional help-seeking for mental health problems in the postpartum period. This study aimed to examine the sociodemographic and clinical correlates of men's intentions to recommend professional help-seeking to their partners if they display postpartum mood and anxiety disorders and to explore the relationship between gender-role conflict and the intention to recommend help-seeking. A cross-sectional study included 214 adult men in a heterosexual relationship with a partner within the reproductive age. Men presented a high intention to recommend professional help to their partners. All dimensions of gender-role conflict were directly associated with the intention to recommend professional help-seeking (p < 0.05). High levels of gender-role conflict (dimensions success, power and competition, and restricted emotionality) were found to lead to increased levels of stigma and lower levels of intention to seek professional help, which, in turn, translated into lower intention to recommend help-seeking. These results emphasize the importance of developing universal awareness-raising and education campaigns directed at men aiming to reduce levels of gender-role conflict and stigma, and normalize the use of mental health services, to increase men's intentions to recommend professional help-seeking to their partners.


Asunto(s)
Depresión Posparto/terapia , Intención , Servicios de Salud Mental/organización & administración , Aceptación de la Atención de Salud/psicología , Parejas Sexuales/psicología , Adolescente , Adulto , Concienciación , Conflicto de Intereses , Estudios Transversales , Femenino , Identidad de Género , Humanos , Masculino , Persona de Mediana Edad , Estigma Social , Encuestas y Cuestionarios , Adulto Joven
19.
BMC Health Serv Res ; 19(1): 691, 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31610790

RESUMEN

BACKGROUND: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub. METHODS: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n = 108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation. RESULTS: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS-DS domains ('Looking forward', p < 0.001; 'Mastering my illness', p < 0.001; and 'Connecting and belonging', p = 0.001). Corresponding improvements, except in 'Connecting and belonging', were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant. CONCLUSIONS: Despite the lack of a control group and small follow-up sample size, Floresco's integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.


Asunto(s)
Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Adulto , Servicio de Urgencia en Hospital/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Organizaciones , Evaluación de Programas y Proyectos de Salud , Queensland
20.
Med Care ; 57(12): 1002-1007, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31568162

RESUMEN

OBJECTIVE: The National Health Service Corps (NHSC) is a federal program to increase the supply of health professionals in underserved communities, but its role in enhancing the capacity of community health centers (CHCs) has not been investigated. This study examined the role of NHSC clinicians in improving staffing and patient care capacity in primary, dental, and mental health care in CHCs. METHODS: Using 2013-2016 administrative data from CHCs and the NHSC, we used a generalized estimating equation approach to examine whether NHSC clinicians [staff full-time equivalents (FTEs)] complement non-NHSC clinicians in CHCs and whether their productivity (patient visits per staff FTE) was greater than that of non-NHSC clinicians in primary, dental, and mental health care. RESULTS: Each additional NHSC clinician FTE was associated with a significant gain of 0.72 non-NHSC clinician FTEs in mental health care in CHCs and an increase of 0.04 non-NHSC FTEs in primary care in CHCs with more severe staffing shortages. On average, every additional NHSC clinician was associated with an increase of 2216 primary care visits, 2802 dental care visits, and 1296 mental health care visits per center-year. The adjusted visits per additional staff for NHSC clinicians were significantly greater in dental (difference=992) and mental health (difference=423) care, compared with non-NHSC clinicians. CONCLUSIONS: The NHSC clinicians complement non-NHSC clinicians in primary care and mental health care. They help enhance the provision of patient care in CHCs, particularly in dental and mental health services, the 2 major areas of service gaps.


Asunto(s)
Centros Comunitarios de Salud/organización & administración , Centros Comunitarios de Salud/estadística & datos numéricos , Área sin Atención Médica , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Atención Odontológica/organización & administración , Atención Odontológica/estadística & datos numéricos , Fuerza Laboral en Salud/organización & administración , Humanos , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/estadística & datos numéricos , Admisión y Programación de Personal/organización & administración
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