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4.
Epidemiol Psychiatr Sci ; 29: e178, 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33148366

RESUMO

employment is critically important in mental health care. Unemployment worsens mental health and gaining employment can improve mental health, even for people with the most serious mental illnesses. In this editorial, we argue for a new treatment paradigm in mental health that emphasises employment, because supported employment is an evidence-based intervention that can help the majority of people with mental health disability to succeed in integrated, competitive employment. Unlike most mental health treatments, employment engenders self-reliance and leads to other valued outcomes, including self-confidence, the respect of others, personal income and community integration. It is not only an effective short-term treatment but also one of the only interventions that lessen dependence on the mental health system over time.


Assuntos
Pessoas com Deficiência/reabilitação , Readaptação ao Emprego/psicologia , Transtornos Mentais/reabilitação , Saúde Mental/estatística & dados numéricos , Adulto , Serviços Comunitários de Saúde Mental/métodos , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde , Humanos , Transtornos Mentais/psicologia , Psicoterapia
5.
Epidemiol Psychiatr Sci ; 29: e169, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996442

RESUMO

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , França/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Qualidade de Vida , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
6.
J Clin Psychiatry ; 81(5)2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32936543

RESUMO

OBJECTIVE: This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. METHODS: 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. RESULTS: Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. CONCLUSIONS: Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.


Assuntos
Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Transtornos Mentais/terapia , Alta do Paciente , Adolescente , Adulto , Assistência Ambulatorial/métodos , Agendamento de Consultas , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York , Pontuação de Propensão , Adulto Jovem
7.
Psychiatr Serv ; 71(10): 1070-1074, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32781926

RESUMO

The global experience of the COVID-19 pandemic is unprecedented. The magnitude, pace, and uncertainty of the pandemic have taxed systems and catalyzed innovation in many fields, including behavioral health. Behavioral health leaders have absorbed changing information about regulations and laws, proper use of personal protective equipment, isolation and quarantine, telepsychiatry practices (broadly defined here as the use of virtual and telephonic means to provide behavioral health care), and financial opportunities and challenges while attending to the mental health needs of local populations. This Open Forum reviews many of the adaptations of the behavioral health system in response to COVID-19 on the basis of a point-in-time snapshot and describes needed multidimensional policy and practice considerations for the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviços Comunitários de Saúde Mental/métodos , Hospitais Estaduais , Humanos , Tratamento Domiciliar , Telemedicina/métodos
9.
Fam Process ; 59(3): 865-882, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32663315

RESUMO

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. In this article, we relate our experiences since the COVID-19 crisis to the lessons we have learned over time as mental health professionals working with families in no-cost, student-managed community comprehensive health clinics in academic-community partnerships. We compare and contrast the learnings of flexibility of time, space, procedures, or attendance we acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID-19 pandemic. We describe families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi-Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. We describe many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Infecções por Coronavirus/psicologia , Emigrantes e Imigrantes/psicologia , Terapia Familiar/métodos , Pneumonia Viral/psicologia , Quarentena/psicologia , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Feminino , Pessoal de Saúde/psicologia , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia , Adulto Jovem
10.
J Prim Care Community Health ; 11: 2150132720943328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32686566

RESUMO

In times of the coronavirus pandemic caused by SARS-CoV-2 psychological support needs to meet certain requirements. Due to the lockdown in many countries of the world, the every-day activities of millions of people are reduced to a minimum. This may cause increased psychosomatic symptoms in persons with pre-existing mental illnesses, and additionally raises new challenges for the general population. As a result of the current contact restrictions, access to psychotherapy is further complicated. To guarantee the best possible care under the given conditions, we developed the CoPE (Coping with Corona: Extended Psychosomatic care in Essen) concept. CoPE is delivered by telephone or video calls as well as online contents. The materials presented at our webpage www.cope-corona.de aim to easily reach citizens affected by symptoms such as worries, depression or anger and let them receive readily understandable expert knowledge and training in basic self-help methods.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Infecções por Coronavirus/psicologia , Transtornos Mentais/prevenção & controle , Pandemias , Pneumonia Viral/psicologia , Apoio Social , Adaptação Psicológica , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Autogestão , Telemedicina
11.
Psychol Trauma ; 12(S1): S225-S227, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32478552

RESUMO

In this article, we comment on the experience of the Kovler Center Child Trauma Program (KCCTP) following the March 21, 2020, shelter at home order in Chicago due to COVID-19. The KCCTP is a program of Heartland Alliance International that was founded in 2018 to provide community-based mental health and social services to immigrant and refugee youth and families who have experienced trauma. COVID-19 temporarily closed the doors of the center, suspending provision of in-person services in the community, and the program was forced to become remote overnight. The KCCTP rapidly transitioned to providing accessible information, active outreach, extensive case management, and flexible delivery of teletherapy and online psychosocial support, finding that attending to structural barriers and basic needs was crucial to family engagement and therapeutic success. Ongoing challenges include technological proficiency and access to computers, Internet, and private spaces. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Sintomas Comportamentais/terapia , Administração de Caso , Serviços Comunitários de Saúde Mental , Infecções por Coronavirus , Emigrantes e Imigrantes , Pandemias , Pneumonia Viral , Trauma Psicológico/terapia , Refugiados , Apoio Social , Telemedicina , Adolescente , Chicago , Criança , Serviços Comunitários de Saúde Mental/métodos , Humanos , Controle de Infecções
12.
Ir J Psychol Med ; 37(3): 181-186, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32434599

RESUMO

COVID-19 has presented society with one of the greatest challenges in living memory. Community Mental Health Teams (CMHTs)have needed to adapt quickly to a rapidly developing situation which has had a dramatic impact on society. In this piece, we describe some of the early challenges for CMHTs within two mental health services based in Dublin and Wicklow. We also discuss ongoing developments and anticipate the need for further vigilance as the COVID-19 pandemic continues to evolve.


Assuntos
Betacoronavirus , Serviços Comunitários de Saúde Mental/métodos , Infecções por Coronavirus/psicologia , Transtornos Mentais/terapia , Pneumonia Viral/psicologia , Serviços de Saúde Rural , Serviços Urbanos de Saúde , Humanos , Irlanda , Transtornos Mentais/psicologia , Pandemias
14.
BMC Psychiatry ; 20(1): 188, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334552

RESUMO

BACKGROUND: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States. METHODS: Retrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014-2017). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state. RESULTS: From 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3406 to 2920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (- 0.52, 95% CI - 1.08 to 0.03; p = 0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths. CONCLUSIONS: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Centros Comunitários de Saúde Mental , Serviços Comunitários de Saúde Mental/tendências , Humanos , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Suicídio/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
15.
PLoS One ; 15(4): e0230896, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271769

RESUMO

BACKGROUND: Individuals who are homeless or vulnerably housed are at an increased risk for mental illness, other morbidities and premature death. Standard case management interventions as well as more intensive models with practitioner support, such as assertive community treatment, critical time interventions, and intensive case management, may improve healthcare navigation and outcomes. However, the definitions of these models as well as the fidelity and adaptations in real world interventions are highly variable. We conducted a systematic review to examine the effectiveness and cost-effectiveness of case management interventions on health and social outcomes for homeless populations. METHODS AND FINDINGS: We searched Medline, Embase and 7 other electronic databases for trials on case management or care coordination, from the inception of these databases to July 2019. We sought outcomes on housing stability, mental health, quality of life, substance use, hospitalization, income and employment, and cost-effectiveness. We calculated pooled random effects estimates and assessed the certainty of the evidence using the GRADE approach. Our search identified 13,811 citations; and 56 primary studies met our full inclusion criteria. Standard case management had both limited and short-term effects on substance use and housing outcomes and showed potential to increase hostility and depression. Intensive case management substantially reduced the number of days spent homeless (SMD -0.22 95% CI -0.40 to -0.03), as well as substance and alcohol use. Critical time interventions and assertive community treatment were found to have a protective effect in terms of rehospitalizations and a promising effect on housing stability. Assertive community treatment was found to be cost-effective compared to standard case management. CONCLUSIONS: Case management approaches were found to improve some if not all of the health and social outcomes that were examined in this study. The important factors were likely delivery intensity, the number and type of caseloads, hospital versus community programs and varying levels of participant needs. More research is needed to fully understand how to continue to obtain the increased benefits inherent in intensive case management, even in community settings where feasibility considerations lead to larger caseloads and less-intensive follow-up.


Assuntos
Administração de Caso , Emprego , Pessoas em Situação de Rua , Habitação , Saúde Mental , Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/métodos , Hospitalização , Humanos , Transtornos Relacionados ao Uso de Substâncias/terapia , Populações Vulneráveis
16.
BMC Public Health ; 20(1): 409, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228533

RESUMO

BACKGROUND: The purpose of the present study was to conduct a pilot randomised controlled trial (RCT) to lend support to a larger effectiveness RCT comparing Mindfulness-Based Stress Reduction (MBSR), a locally-developed stress reduction intervention (LSR) and a waiting list control group in a Danish municipal health care center setting. METHODS: A three-armed parallel pilot RCT was conducted among 71 adults who contacted a Danish municipal health care center due to stress-related problems. Recruitment was made between January and April 2018 and followed usual procedures. EXCLUSION CRITERIA: 1) acute treatment-demanding clinical depression or diagnosis of psychosis or schizophrenia, 2) abuse of alcohol, drugs, medicine, 3) pregnancy. Randomisation was performed by an independent data manager using the REDCap electronic data capture tool. The primary outcome was a description of RCT feasibility (recruitment and retention rates regarding intervention participation and 12-week follow-up). Secondary outcomes were completion rates regarding questionnaire data and proposed effect-estimates of outcome measures considered to be used in the following real RCT. Type of intervention and outcome assessment were not blinded. RESULTS: We recruited 71 of 129 eligible individuals from the target population (55, 95%CI: 46-64). Forty-two (59%) were females. Median age: 44 years (1-quartile:34, 3-quartile:50). Twenty-nine (41%) had < 16 years of education. Forty-eight (68%) were employed; 30 of these 48 (63%) were on sick leave. Mean scores for perceived stress (PSS): 25.4 ± 5.3; symptoms of anxiety and depression (SCL-5): 2.9 ± 0.6, and well-being (WHO-5): 31.7 ± 8.5 indicated a need for intervention. 16/24 (67, 95%CI: 45 to 84) who were allocated to MBSR and 17/23 (74, 95%CI: 52 to 90) who were allocated to LSR participated in ≥5 sessions. The loss to follow-up at 12 weeks: MBSR: 5 (21% (95% CI: 7 to 42), LSR: 5 (22% (95% CI: 7 to 44) and waiting list: 4 (17% (95% CI: 5 to 37). This was acceptable and evenly distributed. The results indicated MBSR to be superior. CONCLUSIONS: An RCT assessing the effectiveness of stress reduction interventions in a real-life municipal health care setting is feasible among adults with a clear need for stress reduction interventions based on scores on mental health. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT03663244. Registered September 10, 2018.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Atenção Plena/métodos , Estresse Psicológico/terapia , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Dinamarca , Depressão/psicologia , Depressão/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Estresse Psicológico/psicologia , Inquéritos e Questionários , Listas de Espera , Adulto Jovem
17.
Global Health ; 16(1): 28, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228648

RESUMO

BACKGROUND: Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. METHODS: A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees' community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. RESULTS: Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. CONCLUSION: Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.


Assuntos
Serviços Comunitários de Saúde Mental/tendências , Comportamento de Busca de Ajuda , Refugiados/psicologia , Adulto , Serviços Comunitários de Saúde Mental/métodos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Líbano , Masculino , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/tendências , Refugiados/estatística & dados numéricos , Estigma Social , Guerra/psicologia , Guerra/estatística & dados numéricos
18.
East Asian Arch Psychiatry ; 30(1): 12-19, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32229642

RESUMO

INTRODUCTION: Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. METHODS: Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. RESULTS: Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. CONCLUSIONS: Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.


Assuntos
Administração de Caso/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Adulto , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
20.
BMJ Open Qual ; 9(1)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32024672

RESUMO

INTRODUCTION: A zoning system is used to ensure that service users receive appropriate levels of support while they are using community mental health team (CMHT) services. Patients are split into red, amber and green zones and are discussed in a daily morning meeting to ensure management plans are in place. We identified that the meeting was an area for improvement as initial feedback indicated that the meeting was repetitive, newcomers to the team found that they did not understand why patients were in different zones and discussions were not being documented. Our three aims for the project were to improve staff-rated satisfaction by 25%, to improve weekly documentation of discussions to 100% and to improve the quality of information handed over by 25% over 4 months. METHODS: We used the Model for Improvement and "plan, do, study, act" (PDSA) cycles to test change ideas such as having someone chair the meeting, use of a 'situation, background, assessment, recommendation, decision' (SBARD) format to handover, introduction of a blue zone for inpatients and documentation in a specific part of the electronic notes at a specific time. RESULTS: We did not find our PDSA cycles led to a consistent change in satisfaction, quality and efficiency. We found an improvement of SBARD use up to 100% although this was not always consistent and an improvement in documentation to 100% for 3 weeks however this was not sustained. CONCLUSION: On examining barriers to change, we found the key to sustaining improvement is in ensuring multidisciplinary team member involvement at all stages of the Quality Improvement project.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Equipe de Assistência ao Paciente/normas , Melhoria de Qualidade/organização & administração , Serviços Comunitários de Saúde Mental/normas , Serviços Comunitários de Saúde Mental/tendências , Humanos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Avaliação de Processos em Cuidados de Saúde/métodos , Melhoria de Qualidade/estatística & dados numéricos
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