Predictors of Frequent Emergency Department Utilization for Mental Health Reasons.

Overcrowding in emergency departments (ED) jeopardizes quality and access to health care, which represents a major issue for service delivery. This study determined predictors of frequent ED utilization among 320 patients recruited from six hospital ED in Quebec (Canada). Data collection included patient interviews and administrative databanks. A hierarchical linear regression analysis was performed using the Andersen Behavioral Model as a framework, with variables organized into predisposing, enabling, and needs factors. Results showed that needs factors were most strongly associated with ED utilization, particularly schizophrenia and personality disorders. Predisposing and enabling factors each contributed one variable to the model: past hospitalization for Mental Health (MH) reasons, and having regular care from an outpatient psychiatrist over the 12 months prior to interview at the ED, respectively. Increasing integration of MH services in networks may reduce unnecessary ED utilization and overcrowding, while providing better accessibility and care continuity for patients who visit ED for MH reasons.

How do childhood conduct problems, callousness and anxiety relate to later offending and adult mental disorder?

BACKGROUND: Various combinations of childhood conduct problems, callous traits and anxiety may confer increased risk of offending, psychopathic traits and mental disorders. Knowledge of these outcomes in adulthood is limited. AIMS: To compare adult criminal convictions, psychopathy checklist scores and mental disorders between five groups of men, variously defined in childhood by: (1) callous traits, (2) conduct problems, (3) conduct problems and callous traits, (4) conduct problems and callous traits and anxiety or (5) developing typically. METHOD: Teachers rated conduct problems, callous traits and anxiety at ages 6, 10 and 12 years. Criminal convictions from age 12 to 24 were extracted from official records. The Psychopathy Checklist-Revised (PCL-R) and diagnostic interviews were completed at age 33. RESULTS: Relative to the typically developing group, the groups with conduct problems, with and without callous traits and anxiety, showed 5-fold elevations in risks of violent convictions and 3 to 4-fold elevations in risk for antisocial personality disorder, while the groups with conduct problems only and with conduct problems plus callous traits plus anxiety were at increased risk for borderline personality disorder. All risk groups obtained higher PCL-R total scores than the typically developing childhood group. CONCLUSIONS AND IMPLICATIONS: It is widely accepted that childhood conduct problems in boys are associated with increased risks of criminal convictions and poorer mental health, but our findings suggest that teachers can identify different subgroups and these have different trajectories. As some subgroups were small, replication is recommended, but our findings offer preliminary support for trialling specific interventions for at risk boys.

Typology of patients who use emergency departments for mental and substance use disorders.

BACKGROUND: Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. AIMS: To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. METHOD: Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. RESULTS: Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. CONCLUSIONS: The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

Relationships Among Structures, Team Processes, and Outcomes for Service Users in Quebec Mental Health Service Networks.

BACKGROUND: Few studies have identified and compared profiles of mental health service networks (MHSN) in terms of structures, processes, and outcomes, based on cluster analyses and perceptions of team managers, MH professionals and service users. This study assessed these associations in Quebec metropolitan, urban and semi-urban MHSN. METHODS: A framework adapted from the Donabedian model guided data management, and cluster analyses were used to identify categories. Study participants included team managers (n = 45), MH professionals (n = 311) and service users (n = 327). RESULTS: For all three MHSN, a common outcome category emerged: service users with complex MH problems and negative outcomes. The Metropolitan network reported two categories for structures (specialized MH teams, primary care MH teams) and processes (senior medical professional, psychosocial professionals), and outcomes (middle-age men with positive outcomes, older women with few MH problems). The Urban and Semi-urban networks revealed one category for structures (all teams) and service user (young service users with drug disorders), but two for processes (psychosocial professionals: urban, all professionals: semi-urban). CONCLUSION: The Metropolitan MHSN showed greater heterogeneity regarding structures and team processes than the other two MHSN. Service user outcomes were largely associated with clinical characteristics, regardless of network configurations for structures and team processes.

Variables associated with interprofessional collaboration: a comparison between primary healthcare and specialized mental health teams.

BACKGROUND: This study has two aims: first, to identify variables associated with interprofessional collaboration (IPC) among a total of 315 Quebec mental health (MH) professionals working in MH primary care teams (PCTs, N = 101) or in specialized service teams (SSTs, N = 214); and second, to compare IPC associated variables in MH-PCTs vs MH-SSTs. METHODS: A large number of variables acknowledged as strongly related to IPC in the literature were tested. Multivariate regression models were performed on MH-PCTs and MH-SSTs respectively. RESULTS: Results showed that knowledge integration, team climate and multifocal identification were independently and positively associated with IPC in both MH-PCTs and MH-SSTs. By contrast, knowledge sharing was positively associated with IPC in MH-PCTs only, and organizational support positively associated with IPC in MH-SSTs. Finally, one variable (age) was significantly and negatively associated with IPC in SSTs. CONCLUSIONS: Improving IPC and making MH teams more successful require the development and implementation of differentiated professional skills in MH-PCTs and MH-SSTs by care managers depending upon the level of care required (primary or specialized). Training is also needed for the promotion of interdisciplinary values and improvement of interprofessional knowledge regarding IPC.

Typology of patients with mental health disorders and perceived continuity of care.

Background: While multiple socio-demographic, clinical and service use variables have been associated with continuity of care (CoC) in patients diagnosed with mental health disorders (MHDs), little is known about how these variables may inform clinical practice and service planning.Aim: This article identified profiles of patients with MHDs to better understand their perceptions of CoC.Method: The sample for this cross-sectional study comprised 327 patients recruited by staff or self-referred from four local health networks in Quebec (Canada). Data were collected using standardized instruments, and patient medical records. A three-factor conceptual framework based on Andersen's Behavioral Model was used, integrating predisposing, needs and enabling factors.Results: Cluster analyses identified five patient profiles. Profiles that included relatively more patients with common MHDs reported less continuity than those with patients primarily affected by severe MHDs.Conclusions: Service planning and delivery should be better adapted to patient profiles in order to improve CoC, and increased access to services prioritized.

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada.

User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio-demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg-Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.

Predictors of Number of Healthcare Professionals Consulted by Individuals with Mental Disorders or High Psychological Distress.

This study assesses the contribution of predisposing, enabling, and needs factors and related variables that predicted the number of healthcare professionals consulted for mental health reasons among 746 individuals with mental disorders and high psychological distress. The data were drawn from the third (T3) and fourth data collection periods (T4) of a longitudinal study conducted in a Quebec/Canada epidemiological catchment area. Hierarchical linear regression was performed on the number of types of healthcare professionals consulted in the 12 months prior to T4. Predictors were identified at T3, classified as predisposing, enabling, and needs factors (i.e., clinical and related variables) according to the Andersen Behavioral Model. Three needs factors were associated with the number of types of healthcare professionals consulted: Post-traumatic stress disorder, stressful events, and marginally suicide ideation. Three enabling factors: Having a family physician, previous use of mental health services, and employment status were also related to the dependent variable. Poor self-perception of mental health status was the only predisposing factor retained. While needs factors were the main predictors of the number of types of healthcare professionals consulted, enabling factors may reduce the influence of needs factors, by the deployment of various strategies that facilitate continuous and appropriate care.

Profiles of Service Users with Severe Mental Disorders Based on Adequacy of Help.

This study has for aims to develop a typology describing adequacy of help based on socio-demographic, clinical and service utilization variables for 204 service users with severe mental disorders treated in the community. Study participants were recruited in an urban area of Quebec (Canada). Adequacy of help was assessed with the Montreal Assessment of Needs Questionnaire. A cluster analysis identified five profiles of service users. Adequacy of help was mainly related to continuity of care, help given by services, seriousness of needs and, to some extent, quality of life (QOL). Adequacy of help was highest among Class 3 participants, described as older individuals with mood disorders, who lived in autonomous housing and enjoyed good QOL. They received substantial help from both relatives and services. Adequacy of help was lowest for Class 5, which included individuals affected by co-occurring mental disorders but who also lived autonomously. Health service utilization was more strongly related to adequacy of help for this sample than were the socio-demographic and clinical factors tested.

Profiling mental health professionals in relation to perceived interprofessional collaboration on teams.

OBJECTIVES: This study aims at identifying profiles of mental health professionals based on individual, interactional, structural and professional role characteristics related to interprofessional collaboration. METHODS: Mental health professionals (N = 315) working in primary health care and specialized mental health teams in four Quebec local service networks completed a self-administered questionnaire eliciting information on individual, interactional, structural and professional role characteristics. RESULTS: Cluster analysis identified four profiles of mental health professionals. Those with the highest interprofessional collaboration scores comprised two profiles labeled "highly collaborative female professionals with fewer conflicts and more knowledge sharing and integration" and "highly collaborative male professionals with fewer conflicts, more participation in decision-making and mutual trust." By contrast, the profile labeled "slightly collaborative professionals with high seniority, many conflicts and less knowledge integration and mutual trust" had the lowest interprofessional collaboration score. Another profile positioned between these groups was identified as "moderately collaborative female psychosocial professionals with less participation in decision-making." DISCUSSION AND CONCLUSION: Organizational support, participation in decision-making, knowledge sharing, knowledge integration, mutual trust, affective commitment toward the team, professional diversity and belief in the benefits of interdisciplinary collaboration were features associated with profiles where perceived interprofessional collaboration was higher. These team qualities should be strongly encouraged by mental health managers for improving interprofessional collaboration. Training is also needed to promote improvement in interprofessional collaboration competencies.

Modeling variables associated with personal recovery among service users with mental disorders using community-based services.

BACKGROUND: Mental health research is evolving toward the identification of conceptual models and associated variables, which may provide a better understanding of personal recovery, given its importance for individuals affected by mental disorders (MDs). AIMS: This article evaluated personal recovery in a sample of adults with MDs using an adapted conceptual framework based on the Andersen behavioral model, which evaluates predisposing, enabling and needs factors in service use. METHODS: The study design was cross-sectional and included 327 mental health service users recruited across four local health service networks in Quebec (Canada). Data were collected using seven standardized instruments and participant medical records. Structural equation modeling was performed. RESULTS: Quality of life (QOL), an enabling factor, was most strongly associated with personal recovery. Health behavior variables associated with recovery included the following: use of alcohol services, having a family physician, consulting a psychologist, use of food banks, consulting fewer professionals and not using drug services. Regarding needs factors, higher numbers of needs, lower severity of unmet health, social and basic needs and absence of mood disorders were also associated with personal recovery. No predisposing factors emerged as significant in the model. CONCLUSION: Findings suggest that QOL, needs variables and comprehensive service delivery are important in personal recovery. Services should be individualized to the health, social and basic needs of service users, particularly those with mood disorders or co-occurring mental health/substance use disorders.

Profiles of Quality of Life in a Homeless Population.

Quality of life (QOL) is a key indicator in mental health planning, program evaluation, and evaluation of patient outcomes. Yet few studies have focused on QOL in homeless populations. More specifically, research has yet to identify profiles of homeless individuals based on their QOL using cluster analysis. This study developed a typology of QOL for a sample of 455 homeless individuals recruited from 27 community and public organizations in Quebec (Canada). The typology was developed based on QOL scores, as well as sociodemographic, clinical, and service use variables. Study participants had to be at least 18 years old, with current or previous experience of homelessness. A questionnaire including socio-demographics, residential history, service utilization, and health-related variables was administered. Four clusters were identified using a two-step cluster analysis. QOL was highest in the cluster consisting of older women with low functional disability, and relatively few episodes of homelessness. The second cluster with high QOL scores included individuals living in temporary housing with relatively few mental health or substance use disorders (SUDs). The third cluster with low QOL included middle-aged women living in temporary housing, with criminal records, personality disorders, and SUDs. QOL was also lower in the fourth cluster composed of individuals with multiple homeless episodes and complex health problems as well as high overall service use. Findings reinforced the importance of disseminating specific programs adapted to the diverse profiles of homeless individuals, with a view toward increasing their QOL.

Variables Associated With Perceived Work Role Performance Among Professionals in Multidisciplinary Mental Health Teams Overall and in Primary Care and Specialized Service Teams, Respectively.

This study had a dual purpose (1) to identify variables associated with perceived work role performance (WRP) among 315 mental health professionals (MHPs) in Quebec and (2) to compare variables related to WRP in MH primary care teams (PCTs) and specialized service teams (SSTs), respectively. WRP was measured using an adapted version of the work role questionnaire. Variables were organized within five areas: individual characteristics, perceived team attributes, perceived team processes, perceived team emergent states, and geographical and organizational context. Half of the WRP variables were linked to team processes. Knowledge sharing correlated with WRP in both MH PCTs and SSTs. Team attributes had more impact on MH PCTs, while team processes and team emergent states played a larger role among SSTs. The association between WRP and knowledge sharing confirms the need for a systematic training program to promote interdisciplinary collaboration. Integration strategies (e.g., service agreements) could improve collaboration between MH PCTs and SSTs and help MHPs perform more effectively within PCTs.

Variables associated with interprofessional collaboration: The case of professionals working in Quebec local mental health service networks.

This study identified variables associated with interprofessional collaboration (IPC) among 315 mental health (MH) professionals working in primary health care (PHC) and specialized teams, within four Quebec (Canada) local service networks (LSNs). IPC was measured with a validated scale, and independent variables were organized according to a four-block conceptual framework that included Individual, Interactional, Organizational and Professional Role Characteristics. Bivariate and multiple linear regression analyses were performed. Five variables were associated with Interactional Characteristics (knowledge sharing, knowledge integration, affective commitment toward the team, team climate, team autonomy), and one variable with Professional Role (multifocal identification) and Individual Characteristics (age), respectively. Findings suggest the importance of positive team climate, knowledge sharing and knowledge integration, professional and team identification (multifocal identification), team commitment and autonomy for strengthening IPC in MH teams. These results suggest that team managers should remain alert to behavioral changes and tensions in their teams that could signal possible deterioration in IPC, while promoting IPC competencies, and interdisciplinary values and skills, in team activities and training programs. As well, the encouragement of team commitment on the part of senior professionals, and support toward their younger counterparts, may enhance IPC in teams.

Modeling Relationships Involving Perceived Recovery Orientation of Mental Health Teams Among Quebec Mental Health Professionals.

While mental health (MH) services are expected to support client recovery, very little is known about services provided by MH teams in relation to this goal. This study explored relationships between a comprehensive collection of team effectiveness variables and the perspectives of MH professionals regarding the recovery orientation of their teams. A model developed by path analysis revealed eight team-related variables that were significantly and positively associated with recovery-oriented teams: primary care versus specialized MH services; greater proportions of clients with severe mental disorders or with suicide ideation on caseloads; knowledge sharing and knowledge production among team members; team climate; work role performance; and trust in coworkers. Results underline the importance of building knowledge and professional competence on MH teams, and the need for a positive team climate that offers flexibility and innovation for addressing the complex needs of people in MH recovery living in the community.

Work-related variables associated with perceptions of recovery-oriented care among Quebec mental health professionals.

BACKGROUND: Provider working conditions are important in mental health service delivery. AIMS: To identify variables associated with perceived recovery-oriented care among mental health professionals. METHOD: A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input-mediator-output-input model and recovery-oriented care. RESULTS: Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations. CONCLUSIONS: Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations. DECLARATION OF INTEREST: None.

Predictors of mental health service use among individuals with high psychological distress and mental disorders.

This study identified predictors of mental health service use over 12 months among 746 individuals with mental disorders and high psychological distress from a catchment area in southwest Montreal, Quebec (Canada). Data collected in 2011 and 2014 were analyzed using Andersen's Behavioral Model of Health Services Use. A hierarchical logistic regression identified predictors of mental health service use. In all, 29% of participants reported using mental health services in the previous 12 months. Three key enabling variables predicted mental health service use: having a family doctor, previous experience with mental health services, and employment. Self-perception of mental health, stressful events, and unmet needs marginally (Needs factors: non-clinical variables) were also associated with the outcome variable. Mental health service utilization depends primarily on organization of the health system, and patient perceptions of its condition (non-clinical needs). Mental health policy should focus on increasing the availability of services and professionals, especially family doctors. Other measures for encouraging service use and overall population wellbeing include raising public awareness around the signs and symptoms of mental illness as a way to promote more rapid response to patient needs, and protecting workplace mental health by reducing stress and stigma toward individuals affected by mental distress.

Variables associated with job satisfaction among mental health professionals.

Recent mental health (MH) reforms have had a sharp impact on practices among MH professionals. A deeper understanding of factors contributing to their job satisfaction, in this context, may help improve quality and continuity of care. The purpose of this study was to identify variables associated with job satisfaction for 315 MH professionals in Quebec (Canada) after implementation of wide-ranging MH reforms. Job satisfaction was measured with the Job Satisfaction Survey. Independent variables were conceptualized within five domains: 1) Professional Characteristics, 2) Team Attributes, 3) Team Processes, 4) Team Emergent States, and 5) Organizational Culture. Univariate, bivariate and multivariate analyses were performed. Job satisfaction was significantly associated with absence of team conflict, stronger team support, better team collaboration, greater member involvement in the decision-making process (Team Processes), Affective commitment toward the team (Team Emergent States), as well as lack of a market/rational culture (Organizational Culture). Job satisfaction was strongly related to team processes and, to a lesser extent, team emergent states.

Changes in percentages of perceived met needs for care over time in a Canadian longitudinal cohort.

There is a paucity of research on determinants associated with changes in perceived met needs for care over time. This study used a longitudinal cohort to explore changes in percentages of perceived met needs over time and to identify its related determinants. Data analyzed was from a longitudinal community-based survey. A total of 150 participants received at least one type of help both at baseline and a 2-year follow-up. Multivariate analyses were used. Perceived met needs of the study sample slightly increased over time. People who had a higher percentage of met needs at baseline were less likely to have an increase in percentage of perceived met needs at the 2-year follow-up, whereas, those who had a higher value of wellbeing and an increase in the value of mental wellbeing over time, were associated with an increase in the percentage of met needs at the 2-year follow-up. Determinants associated with changes in percentages of perceived met needs could be the target for improving perceived need for mental health care. Findings of this study indicate the need for longitudinal studies in perceived need for mental health services.

Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis.

This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.