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Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31928567


AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.

Depressão/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Comportamento de Busca de Ajuda , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Sistemas de Informação Geográfica , Pesquisas sobre Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Índia , Masculino , Vigilância da População , Fatores de Tempo
Medicine (Baltimore) ; 99(1): e18635, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895824


This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Psicotrópicos/uso terapêutico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
Epidemiol Psychiatr Sci ; 29: e87, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915090


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.

Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde , Serviços de Saúde Mental/organização & administração , Transição para Assistência do Adulto , Adolescente , Criança , Progressão da Doença , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Cuidado Transicional , Adulto Jovem
Epidemiol Psychiatr Sci ; 29: e90, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915102


For young people with autism spectrum disorder (ASD), the transition from childhood to adulthood especially for those with additional mental health problems can be challenging. Increasing numbers of young people attending child and adolescent mental health services (CAMHS) have a recognised diagnosis of ASD. What are the outcomes of these young people when they are discharged from CAMHS and how best can services support their needs? In this editorial we consider the emerging literature on transition for young people with long-term conditions and in particular those with ASD. Longer term studies suggest that the outcomes for individuals with ASD across the ability range is mostly poor and that healthcare transfer has generally not been managed well, with service users often reporting a lack of appropriate types of support. Encouragingly there is an increasing awareness of the need to support young people with long-term conditions as they negotiate the many developmental tasks of transition to adulthood. However, less is known about the experiences and aspirations of autistic individuals of all abilities as they transition to adulthood. This knowledge can inform a more nuanced approach to identifying developmentally appropriate outcomes. Recent studies with cognitively able young people with ASD, highlight some features in common with young people with long-term conditions but also the importance of identifying ways to foster underlying skills and the ability of young people with ASD to develop and maintain relationships. Child-focussed and adult-orientated healthcare services need to work directly with autistic individuals and their support networks to facilitate successful engagement with services and enable adults to manage their mental health needs. There is an urgent need to investigate the implementation and effectiveness of research and clinical guideline recommendations that aim to increase wellbeing, health self-efficacy and improve the mental health outcomes for autistic adults.

Transtorno do Espectro Autista/terapia , Assistência à Saúde , Serviços de Saúde Mental , Transição para Assistência do Adulto , Adolescente , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Saúde Mental , Adulto Jovem
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31343744


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.

Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Prisioneiros/psicologia , Prisões , Adulto , Coinfecção , Feminino , Infecções por HIV/epidemiologia , Hepatite C Crônica/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Polimedicação , Estudos Prospectivos , Psicotrópicos/uso terapêutico , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
Lancet Psychiatry ; 7(1): 78-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474568


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.

Prestação Integrada de Cuidados de Saúde , Planejamento em Saúde , Transtornos Mentais , Serviços de Saúde Mental , Atenção Primária à Saúde , Adulto , Países em Desenvolvimento , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Pobreza
Trab. educ. saúde ; 18(1): e0023167, 2020. tab
Artigo em Português | LILACS | ID: biblio-1043488


Resumo Trata-se de um estudo qualitativo que analisou práticas de cuidado territoriais em saúde mental realizadas por enfermeiros, agentes comunitários de saúde e usuários dos centros de atenção psicossocial e da atenção básica. Foram realizadas entrevistas, grupos focais e observação livre com 60 participantes de Fortaleza, Ceará, em 2017. A análise das informações fundamentou-se na hermenêutica-dialética ante um exercício interpretativo crítico e reflexivo. Os resultados evidenciaram que o processo de territorialização é realizado pela equipe multidisciplinar da Estratégia Saúde da Família, sem a participação dos profissionais do centro de atenção psicossocial. Embora estes, por vezes, realizem práticas comunitárias, persiste a valorização de ações dentro do próprio serviço e na medicalização do sofrimento psíquico, sem considerar as singularidades dos sujeitos e sem articulação com os serviços da atenção básica. Os agentes comunitários de saúde, se treinados, são atores potencialmente estratégicos para atuar na interface da saúde mental com a atenção básica. Com efeito, o panorama da saúde mental urge pela transformação de um modelo que privilegie a reflexão de novas ações em múltiplas dimensões, com ênfase na articulação dos serviços e na capacitação dos trabalhadores que atuam nesse âmbito.

Abstract This is a qualitative study that analyzed the practices of territorial care in mental health developed by nurses, community health workers and users of the psychosocial care centers and of primary health care. We conducted interviews, focus groups and free observation with 60 participants from the city of Fortaleza, state of Ceará, Brazil, in 2017. The data analysis was based on hermeneutics-dialectics in the face of a critical and reflective interpretive exercise. The results revealed that the territorialization process is developed by the multidisciplinary team from the Health of the Family Strategy, without the participation of the professional of the psychosocial care center. Even though they may sometimes develop community practices, they still privilege actions within the service itself and those focusing on the medicalization of mental suffering, without taking into consideration the singularities of the subjects, and with no interaction with the primary health care services. The community health workers, if trained, are potentially strategic actors to work on the interface between mental health and primary health care. In fact, the mental health outlook urges for the transformation of a model that privileges the reflection of new actions into multiple dimensions, with an emphasis on the connection of the services and the training of the workers that act in this context.

Resumen Se trata de un estudio cualitativo que analizó prácticas de cuidado territoriales en salud mental realizadas por enfermeros, agentes comunitarios de salud y usuarios de los centros de atención psicosocial y de la atención básica. Han sido realizadas entrevistas, grupos focales y observación libre con 60 participantes de la ciudad de Fortaleza, estado de Ceará, Brasil, en 2017. El análisis de las informaciones estuvo basado en la hermenéutica-dialéctica ante un ejercicio interpretativo crítico y reflexivo. Los resultados evidenciaron que el proceso de territorialización es realizado por el equipo multidisciplinario de la Estrategia Salud de la Familia, sin la participación de los profesionales del centro de atención psicosocial. Aunque ellos a veces realicen prácticas comunitarias, persiste la valoración de acciones dentro del propio servicio y en la medicalización del sufrimiento psíquico, sin considerar las singularidades de los sujetos, y sin articulación con los servicios de la atención básica. Los agentes comunitarios de salud, si entrenados, son actores potencialmente estratégicos para actuar en la interconexión de la salud mental con la atención básica. De hecho, el panorama de la salud mental urge por la transformación de un modelo que privilegie la reflexión de nuevas acciones en múltiples dimensiones, con énfasis en la articulación de los servicios y en la capacitación de los trabajadores que actúan en ese ámbito.

Humanos , Atenção Primária à Saúde , Saúde Mental , Agentes Comunitários de Saúde , Assistência Integral à Saúde , Serviços de Saúde Mental
Trab. educ. saúde ; 18(1): e0023266, 2020. tab
Artigo em Português | LILACS | ID: biblio-1043491


Resumo O estudo do tipo qualitativo e transversal, com o objetivo de analisar a perspectiva dos profissionais dos centros de atenção psicossocial acerca do apoio matricial como estratégia de cuidado psicossocial em saúde mental. Foram utilizadas dez entrevistas semiestruturadas com profissionais de serviços de saúde mental do município de Imperatriz, Maranhão. Depreendeu-se que esses profissionais compreendem o apoio matricial como ferramenta indispensável para a organização do cuidado psicossocial, mas este ainda é utilizado de modo incipiente no seu cotidiano de trabalho ante os desafios relativos à: coexistência do modelo psicossocial com o biomédico; falta de condições de trabalho; falta de educação continuada e permanente da rede de atenção; burocratização e verticalização das ações da gestão; e motivação para o trabalho entre as equipes. Algumas vivências exitosas de apoio matricial para esses trabalhadores resultaram da cogestão dos processos de trabalho entre profissionais e usuários. Recomenda-se que haja um claro direcionamento do trabalho por parte da gestão, com a definição de uma equipe de matriciadores e um planejamento para sua realização, construindo processos de trabalho que favoreçam tal prática.

Abstract The present qualitative and cross-sectional study has the aim of analyzing the perspective of the professionals of the psychosocial care centers regarding the matrix support as a psychosocial care strategy in mental health. We used ten semi-structured interviews with mental health service professionals from the municipality of Imperatriz, in the state of Maranhão, Brazil. We concluded that these professionals understand matrix support as an indispensable tool to organize psychosocial care, but it is still used incipiently in their everyday practice regarding the following challenges: coexistence of the psychosocial and biomedical models; lack of work conditions; lack of permanent and ongoing education in the care network; bureaucratization and verticalization of the management actions; and motivation to work on the part of the teams. Some successful experiences regarding matrix support for these workers resulted from the co-management of work processes between professional and users. We recommend that there be a clear direction of the work on the part of the management, with a definition of a team of matrix workers and a planning for its development, creating work processes that favor such a practice.

Resumen Este es un estudio cualitativo y transversal, con el objetivo de analizar la perspectiva de los profesionales de los centros de atención psicosocial sobre el apoyo matricial como estrategia de cuidado psicosocial en salud mental. Han sido utilizadas diez entrevistas semiestructuradas con profesionales de servicios de salud mental del municipio de Imperatriz, en el estado de Maranhão, Brasil. Se concluyó que eses profesionales comprenden el apoyo matricial como herramienta indispensable para la organización del cuidado psicosocial, pero este aún es utilizado de modo incipiente en su cotidiano laboral frente a desafíos relacionados a: la coexistencia de los modelos psicosocial y biomédico; falta de condiciones laborales; falta de educación continua y permanente de la red de atención; burocratización y verticalización de las acciones de la gestión; y motivación para el trabajo entre los equipos. Algunas vivencias exitosas de apoyo matricial para esos trabajadores resultaron de la cogestión de los procesos de trabajo entre profesionales y usuarios. Se recomienda que haya un claro direccionamiento del trabajo por parte de la gestión, con la definición de un equipo de matriciadores y una planificación para su realización, construyendo procesos de trabajo que favorezcan tal práctica.

Humanos , Sistemas de Apoio Psicossocial , Serviços de Saúde Mental
Lancet ; 394(10216): 2237-2238, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31868622
J Clin Nurs ; 29(1-2): 31-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532022


AIMS AND OBJECTIVES: To analyse the experiences of older people with a diagnosed functional mental illness and their carers in relation to mental health service delivery and analyse the experiences of health and social care professionals who care for and treat older people who have a diagnosed functional mental illness. BACKGROUND: The prevalence of functional mental illness in older adults is notable but to date has received less research attention than dementia. Older adults with functional mental illness have life expectancy of up to 20 years less than the rest of the population. Therefore, the experiences of older adults with functional mental illness, their carers and healthcare professionals, in relation to mental health services, need further exploration. DESIGN: Integrative literature review. METHODS: A five-stage process was informed by Whittemore and Knafl. MeSH was used. Keyword searches of MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE and AMED were conducted between January 2000-October 2017. Titles were screened, and data were extracted manually and analysed using narrative synthesis. The PRISMA checklist was used. RESULTS: A total of 342 articles were deemed potentially relevant to this review. Once inclusion and exclusion criteria were applied, 28 articles were included. The literature presented an overarching theme "determinants influencing older people with functional mental illness use of services." The overarching theme is supported by two main themes: inevitable consequences of ageing and variations of the availability of healthcare services for older people with functional mental illness. CONCLUSION: Several determinants influence use of services by older people with functional mental illness. Older people with functional mental illness often perceived they did not have a mental health need. Within the literature, there was little acknowledgement of the experiences of older people with functional mental illness regarding their support needs. RELEVANCE TO CLINICAL PRACTICE: This integrative review has highlighted that some older people with functional mental illness do not seek mental health support because they believe that functional mental illness is an inevitable consequence of ageing; this is mirrored at times by healthcare professionals and carers. In addition to this finding, different views prevail regarding the impact that ageless and age-defined mental health service delivery models have on the needs of older people with functional mental illness. Further research is required to understand these findings.

Envelhecimento/psicologia , Cuidadores/psicologia , Transtornos Mentais/psicologia , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Feminino , Serviços de Saúde para Idosos/organização & administração , Humanos , Transtornos Mentais/enfermagem , Serviços de Saúde Mental
J Ment Health Policy Econ ; 22(3): 85-94, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811752


BACKGROUND: Since the introduction and soaring popularity of the managed behavioral healthcare (BH) "carve-out" model in the 1980s, policymakers have been concerned with their impact on access. In carve-outs, BH and medical benefits are administered separately. Earlier literature found they reduced intensity of service use while maintaining penetration rates. Recently it has become more common for employers to drop existing carve-out contracts, partly due to the Mental Health Parity and Addiction Equity Act (MHPAEA), which placed a greater administrative burden on carve-outs for parity compliance. Although prior studies focused exclusively on the impact of moving from carve-in to carve-out models, it is now more policy-relevant to understand the effects of the move from carve-out to carve-in, which may not be symmetric. Moreover, the natural experiment resulting from MHPAEA implementation may attenuate concerns about selection bias. STUDY AIMS: This study examines how specialty BH care patterns change when employees and dependents are moved from a "carve-out" plan to a "carve-in" plan. METHODS: Linked insurance claims, eligibility, plan and employer data from 2008-14 were obtained for three Optum( employers who dropped their carve-out contracts but retained their carve-in plans. A longitudinal "difference-in-differences" study design was used to compare changes in BH services use over time among individuals who were: (i) moved to carve-in plans when the employer dropped its carve-out contract (N=177,653); and (ii) enrolled in carve-in plans before and after the transition (N=58,658). Outcomes included total and inpatient expenditures, broken down by plan, patient, and total; outpatient visits for assessment, individual psychotherapy, family psychotherapy, and medication management; and days of structured outpatient care, day treatment, residential care, and acute inpatient care. We pooled person-year observations and estimated regressions including individual fixed effects, year dummies and interactions between indicators for post-transition period and whether transitioned from carve-out to carve-in. RESULTS: Relative to individuals continuously in carve-in plans, those who were transitioned experienced significant increases in inpatient utilization (beta =.02; p=.05) and patient inpatient costs (beta =2.35; p=.01) and decreases in day treatment (beta =-0.01; p=.02). Our conclusions proved robust against potential biases due to differing secular time trends and differential changes in benefits resulting from MHPAEA. DISCUSSION: The increased inpatient utilization associated with switching from carve-out to carve-in plans is consistent with previous literature. Carve-outs may use day treatment to reduce inpatient care so that increased inpatient utilization post-transition reduced demand for day treatment. Limitations include possible selection bias at the employer level; lack of data on medication and generalist use, quality, clinical endpoints and quality of life; and potential lack of generalizability. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The reduction in the use of carve-out contracts by private employers associated with MHPAEA implementation likely did not have a net negative impact and may have actually increased access to care among former carve-out enrollees in need of inpatient services. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should consider and evaluate possible unintended consequences of legislation designed to improve access to care. IMPLICATIONS FOR FURTHER RESEARCH: Future work should replicate these analyses with a more representative sample.

Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Humanos , Saúde Mental , Psiquiatria , Qualidade de Vida , Estados Unidos
Mayo Clin Proc ; 94(12): 2510-2523, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806104


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.

Serviços de Saúde Mental/organização & administração , Telemedicina/organização & administração , Humanos , Videoconferência
Epidemiol Psychiatr Sci ; 29: e81, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839018


AIMS: Patients with severe mental disorders in low-resource settings have limited access to services, resulting in overwhelming caregiving burden for families. In extreme cases, this has led to the long-term restraining of patients in their homes. China underwent a nationwide initiative to unlock patients and provide continued treatment. This study aims to quantify household economic burden in families after unlocking and treatment, and to identify factors associated with increased burden due to schizophrenia. METHODS: A total of 264 subjects were enrolled from three geographically diverse provinces in 2012. Subjects were patients with schizophrenia who were previously put under restraints and had participated in the 'unlocking and treatment' intervention. The primary outcome was the current household economic burden, obtained from past year financial information collected through on-site interview. Patient disease characteristics, treatment, outcomes and family caregiving burden were collected as well. Univariate and multivariate linear regression were used to construct risk factor models for indirect economic burden. RESULTS: After participating in the intervention, 85% of patients continued to receive mental health services, 70% used medication as prescribed and 80% were never relocked. Family members reported significantly decreased caregiving burden after receiving the intervention. Mean direct and indirect household economic burdens were CNY963 (US$31.7) and CNY11 724 (US$1670) per year, respectively, while family total income was on average CNY12 108 (US$1913) per year. Greater disease severity and poorer patient psychosocial function at time of study were found to be independent factors related to increased indirect burden. CONCLUSIONS: The 'unlocking and treatment' intervention has improved the lives of patients and families. Indirect burden due to disease is still a major economic issue that needs to be addressed, potentially through improving treatment and patient functioning. Our findings contribute to the unravelling and eventual elimination of chronic restraining of mentally ill patients in low-resource settings.

Cuidadores/psicologia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Gastos em Saúde , Serviços de Saúde Mental/economia , Esquizofrenia/terapia , Adolescente , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/economia , Psicologia do Esquizofrênico , Inquéritos e Questionários , Adulto Jovem
Epidemiol Psychiatr Sci ; 29: e80, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839026


AIMS: No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of 'professional culture' as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers. METHODS: The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design. RESULTS: Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability. CONCLUSIONS: This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.

Atitude do Pessoal de Saúde/etnologia , Competência Cultural , Assistência à Saúde Culturalmente Competente , Pessoal de Saúde/psicologia , Serviços de Saúde Mental/normas , Inquéritos e Questionários/normas , Adulto , Canadá , Comparação Transcultural , Humanos , Itália , Saúde Mental , Pessoa de Meia-Idade , Cultura Organizacional , Psicometria , Reprodutibilidade dos Testes
Soins Psychiatr ; 40(325): 25-28, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31836066


Introduced in 1954, the terms of "advanced nursing practice" take into account advances and newly developed practices. They are based on care, prevention and health education missions, as well as research and the defence of the rights of users and their family. In a context where the first advanced practice nurses (APNs) in mental health in France are coming to the end of their training and where the health care directorate is recommending that psychosocial rehabilitation is integrated into all psychiatric teams, the role of APNs in this field could include the provision of support to area teams in the gradual setting up of these practices and their direct implementation with users. The establishment of the function of case manager appears to be key to providing the support required to meet the specific needs of each patient.

Prática Avançada de Enfermagem , Serviços de Saúde Mental , Reabilitação Psiquiátrica , França , Humanos , Saúde Mental