Measuring the intensity of mental healthcare: development of the Mental Healthcare Intensity Scale (MHIS).

BACKGROUND: There are considerable differences among mental healthcare services, and especially in developed countries there are a substantial number of different services available. The intensity of mental healthcare has been an important variable in research studies (e.g. cohort studies or randomized controlled trials), yet it is difficult to measure or quantify, in part due to the fact that the intensity of mental healthcare results from a combination of several factors of a mental health service. In this article we describe the development of an instrument to measure the intensity of mental healthcare that is easy and fast to use in repeated measurements. METHODS: The Mental Healthcare Intensity Scale was developed in four stages. First, categories of care were formulated by using focus group interviews. Second, the fit among the categories was improved, and the results were discussed with a sample of the focus group participants. Third, the categories of care were ranked using the Segmented String Relative Rankings algorithm. Finally, the Mental Healthcare Intensity Scale was validated as a coherent classification instrument. RESULTS: 15 categories of care were formulated and were ranked on each of 12 different intensities of care. The Mental Healthcare Intensity Scale is a versatile questionnaire that takes 2-to-3 min to complete and yields a single variable that can be used in statistical analysis. CONCLUSIONS: The Mental Healthcare Intensity Scale is an instrument that can potentially be used in cohort studies and trials to measure the intensity of mental healthcare as a predictor of outcome. Further study into the psychometric characteristics of the Mental Healthcare Intensity Scale is needed.

Measuring personal recovery in a low-intensity community mental healthcare setting: validation of the Dutch version of the individual recovery outcomes counter (I.ROC).

BACKGROUND: Measuring progress in treatment is essential for systematic evaluation by service users and their care providers. In low-intensity community mental healthcare, a questionnaire to measure progress in treatment should be aimed at personal recovery and should require little effort to complete. METHODS: The Individual Recovery Outcome Counter (I.ROC) was translated from English into Dutch, and psychometric evaluations were performed. Data were collected on personal recovery (Recovery Assessment Scale), quality of life (Manchester Short Assessment of Quality of Life), and symptoms of mental illness and social functioning (Outcome Questionnaire, OQ-45) for assessing the validity of the I.ROC. Test-retest reliability was evaluated by calculating the Intraclass Correlation Coefficient and internal consistency was evaluated by calculating Cronbach's alpha. Exploratory factor analysis was performed to determine construct validity. To assess convergent validity, the I.ROC was compared to relevant questionnaires by calculating Pearson correlation coefficients. To evaluate discriminant validity, I.ROC scores of certain subgroups were compared using either a t-test or analysis of variance. RESULTS: There were 764 participants in this study who mostly completed more than one I.ROC (total n = 2,863). The I.ROC aimed to measure the concept of personal recovery as a whole, which was confirmed by a factor analysis. The test-retest reliability was satisfactory (Intraclass Correlation Coefficient is 0.856), as were the internal consistency (Cronbachs Alpha is 0.921) and the convergent validity. Sensitivity to change was small, but comparable to that of the OQ-45. CONCLUSIONS: The Dutch version of the I.ROC appears to have satisfactory psychometric properties to warrant its use in daily practice. Discriminant validity and sensitivity to change need further research.

Can social support be improved in people with a severe mental illness? A systematic review and meta-analysis.

People with a severe mental illness often have less social support than other people, yet these people need social support to face the challenges in their lives. Increasing social support could benefit the person's recovery, but it is not clear whether interventions that aim to improve social support in people with a severe mental illness are effective. A systematic literature search and review in MEDLINE (PubMed), PsycINFO, CINAHL, Cochrane, JSTOR, IBSS, and Embase was performed. Studies were included if they had a control group and they were aimed at improving social support in people with a severe mental illness who were receiving outpatient treatment. Summary data were extracted from the research papers and compared in a meta-analysis by converting outcomes to effect sizes (Hedges's g). Eight studies (total n = 1538) that evaluated ten different interventions met the inclusion criteria. All but one of these studies was of sufficient quality to be included in the review. The studies that were included in the meta-analysis had a combined effect size of 0.17 (confidence interval: 0.02 to 0.32), indicating a small or no effect for the interventions that were evaluated. A subgroup analysis of more personalized studies showed a combined effect size of 0.35 (CI = 0.27 to 0.44), indicating a noteworthy effect for these more personalized studies. This evaluation of interventions aimed at improving social support in people with a severe mental illness suggests that these interventions in general have little or no clinical benefit. However, in a subgroup analysis the more personalized interventions have a larger effect on improving social support and merit further research.

Measuring Social Support in People with Mental Illness: A Quantitative Analysis of the Social Network Map.

An instrument is needed for quantitatively evaluating changes in social support in people with mental illness, but no gold standard is available. The Social Network Map is a structured interview for assessing social support that is used in individual care settings, yet provides overwhelming output (16-128 data points per assessment). A method comprising two factors (quality and quantity of the social network) was developed. The psychometric properties were judged to be sufficient. This study shows that data from the Social Network Map can be analysed at the group level, yet further research on the psychometric properties is needed.

Accessibility of substance use treatment: A qualitative study from the non-service users' perspective.

INTRODUCTION: Despite having effective treatments for substance use disorders, the majority of people with a substance use disorder do not receive treatment, which leads to adverse personal, health, and social consequences. Experiences of non-service users have hardly been investigated in the literature. This study, which we conducted in the Netherlands, assessed the barriers to and facilitators of accessibility to substance use treatment for non-service users with substance use disorders. METHODS: The study team conducted a total of 10 individual, semi-structured interviews with participants recruited with the help of assertive outreach teams and public health services. A topic list guided the interviews. The interviews were transcribed, and the study team performed a thematic analysis. RESULTS: Six main themes related to the health care accessibility of substance use treatment emerged: treatment factors, stigmatization, personal factors, consequences of use, knowledge deficits, and social support. Personal factors, especially the non-service users' motivation, was a central determinant of whether they accessed substance use treatment. Social support and consequences of the substance use were perceived as facilitating access to treatment. Stigmatization and knowledge deficits had an important negative impact on the substance users' intrinsic motivation and thus on their ability to access health care. Specifically, stigmatization by health care professionals contributed to suboptimal treatment and recovery. CONCLUSIONS: This study recommends interventions for health care professionals aimed at decreasing their stigma toward and knowledge deficits about substance use disorder. This study highlights the key role that primary health care providers can have in identifying substance use problems and facilitating the pathway to health care services for those with substance use disorders.

Personal-recovery-oriented community mental healthcare: qualitative evaluation of a developmental project.

OBJECTIVES: Mental healthcare is commonly aimed at reducing symptoms in individual service users. When only symptomatic recovery is addressed, not all service users experience sufficient recovery, and when care is aimed only at individuals (instead of the neighbourhood), not all people in need of mental healthcare are reached. This study evaluated a project that aimed to improve mental healthcare in a neighbourhood, by improving healthcare providers' outreach to the residents living in the neighbourhood, by improving collaboration among healthcare providers and focussing on the residents' personal recovery. This project was carried out by several public health services. It aimed to change the goal of mental healthcare provided in the neighbourhood from symptom reduction to personal recovery. DESIGN: The study included qualitative focus groups and inductive content analysis. SETTING: Primary and secondary mental healthcare that healthcare workers from different healthcare services provided. PARTICIPANTS: The evaluation was conducted through three focus group interviews with services users, their friends and relatives, neighbourhood residents, neighbourhood representatives and the healthcare services that were involved (n = 24). RESULTS: Evaluation indicated that the most valued part of the project was the utilisation of peer workers at the initiation of mental healthcare. Improved communication among healthcare providers that the project fostered was also highly regarded. The aim of the project to align it with existing initiatives in the neighbourhood was also considered important, although it was difficult to achieve. CONCLUSIONS: The project did not find a panacea for recovery-oriented community mental healthcare. A variety of its components did, however, contribute to the mental health of the community residents.

Substituting specialist care for patients with severe mental illness with primary healthcare. Experiences in a mixed methods study.

WHAT IS KNOWN ON THE SUBJECT?: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. Most patients with severe mental illness receive long-term treatment from specialized mental health services. This long-term, highly intensive treatment is not always the best option for two reasons. Firstly, because as long as a patient receives intensive treatment aimed at safety, it is hard for that patient to take full responsibility for their own life. Secondly, because care is not available unlimitedly, some patients are waiting to receive specialist mental healthcare while others who do not need it anymore still receive it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most stable patients with severe mental illness can be treated outside of specialized mental health services. Some patients are too dependent on a specific mental healthcare professional to be referred to primary healthcare. In such instances, a referral will most likely lead to destabilization and the referral will therefore be unsuccessful. Patients preferred primary healthcare to specialized mental health services, mainly because of the absence of stigma associated with the latter. There should be more attention for personal recovery (especially the social support system) of patients with severe mental illness who are referred to primary healthcare services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Most stable patients with severe mental illness can be treated in primary healthcare. Professionals in primary healthcare should keep personal recovery in mind when treating patients, focusing on problem solving skills and also making use of social support systems. ABSTRACT: Aim/question Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. In the United Kingdom and the Netherlands, most patients with severe mental illness receive long-term specialized mental healthcare, even when they are stable. This study aims to explore the outcome of these stable patients when they are referred to primary healthcare. Methods Patients (N = 32) receiving specialized mental healthcare that were referred to primary healthcare were interviewed in focus groups, as were the involved professionals (N = 6). Results 84% of the participants still received primary healthcare after 12 months. Despite the successful referral, the patient's personal recovery did not always profit. The participants of the focus groups agreed that some patients were too dependent on a specific mental healthcare professional to be referred to primary healthcare. Discussion Most stable patients with severe mental illness can be referred to primary healthcare. Personal recovery and dependency on a specific healthcare provider should be considered when referring a patient to primary healthcare. Implications for practice Professionals in community mental healthcare teams should consider a referral to primary mental healthcare in stable patients. Professionals in primary healthcare should keep the patient's personal recovery in mind.

Potential predictive factors for successful referral from specialist mental-health services to less intensive treatment: A concept mapping study.

Referring patients from specialist mental-health services (provided by multiple healthcare service providers and aimed at relieving symptoms of mental illness) to less intensive care (provided by a nurse or psychologist in cooperation with a general practitioner and aimed at improving quality of life) is feasible from the perspective of patients, service providers, and mental-health services. However, it is unclear which patients are most suitable for referral to less intensive care. In this study, we used concept mapping to identify factors that might determine whether a referral from specialist mental services to less intensive care might be successful. Participants (N = 34) were recruited from different parts of the Netherlands and included general practitioners, peer workers, community mental-health nurses, and social workers from several services who were based in different neighborhoods. The participants generated 54 statements (31 after clean-up), which were sorted into five clusters and rated on their expected ability to predict successful referral. Ordered from highest to lowest on expected predictive value, the clusters of factors were: Patient characteristics, patients' informal support system, patients' social situation, organization of services, and service provider related factors. The ordering was the same for all of the service providers, except that general practitioners expected the organization of services to be the most predictive. The ordering of the clusters is mostly consistent with existing knowledge about recovery during mental healthcare. In order to further improve the number of successful referrals from specialist mental-health services to less intensive care, a prospective prediction study is needed.