Quality assessment of mental health rehabilitation services

2016 ◽  
Vol 33 (S1) ◽  
pp. S6-S6
Author(s):  
H. Killaspy
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Quality Assessment ◽  
Assessment Tool ◽  
Health Care Facilities ◽  
Rehabilitation Services ◽  
Inpatient Mental Health ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

ObjectivesProviding good quality mental health care is vital to achieve better outcomes but service quality is a complex, multidimensional construct that extends beyond the delivery of specific evidence based treatments and interventions. This makes it difficult to operationalize and measure, particularly at the international level where different socioeconomic and political contexts impact. Mental health rehabilitation services focus on people with severe and complex psychosis. This group are one of the most socially excluded in society and are vulnerable to exploitation and abuse. They are also, be definition, difficult to treat and, historically, have often been institutionalised in hospital or community facilities.AimsThis presentation will report on the development and application of an internationally validated quality assessment tool for longer term mental health care facilities, the Quality Indicator for Rehabilitative Care (QuIRC).MethodsThe content of the QuIRC was derived from a systematic literature review, international Delphi exercise and review of care standards in ten European countries. Its psychometric properties were assessed in over 200 longer-term mental health facilities across Europe involving validation with over 1750 service users. It has subsequently been used in a national programme of research into inpatient mental health rehabilitation services in England which will also be briefly described.ResultsThe QuIRC has excellent inter-rater reliability and validity. Specific aspects of care assessed by the QuIRC have been found to be associated with successful community discharge from inpatient mental health rehabilitation services.ConclusionsThe QuIRC is a free to use, standardised and validated on-line international quality assessment benchmarking and research tool, available in ten European languages.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

2017 ◽  
Vol 5 (7) ◽  
pp. 1-284 ◽  
Author(s):  
Helen Killaspy ◽  
Michael King ◽  
Frank Holloway ◽  
Thomas J Craig ◽  
Sarah Cook ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
National Survey ◽  
Assessment Tool ◽  
Rehabilitation Services ◽  
Service Users ◽  
Inpatient Mental Health ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

Welfare State Replacements: Deinstitutionalization, Privatization and the Outsourcing to Immigrant Women Enterprise

2018 ◽  
Vol 48 (2) ◽  
pp. 247-266 ◽  
Author(s):  
Jennifer Nazareno
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Welfare State ◽  
Mental Health Care ◽  
Immigrant Women ◽  
Health Care Facilities ◽  
Direct Care ◽  
Term Care ◽  
Severely Mentally Ill ◽  
The U.S

The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women–owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.

Mental health policy in Greece: Implications into practice in the era of economic crisis

2011 ◽  
Vol 26 (S2) ◽  
pp. 539-539 ◽  
Author(s):  
I. Grammatikopoulos ◽  
S. Koupidis ◽  
E. Petelos ◽  
P. Theodorakis
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Mental Health Care ◽  
Economic Crisis ◽  
Rural Areas ◽  
Care Delivery ◽  
Mental Health Policy ◽  
Regional Distribution ◽  
Health Care Facilities

IntroductionBudgets allocated for mental health make up a relatively small proportion of total health expenditures, although there is an increasing burden of mental disorders.ObjectivesTo review the mental health situation in Greece with regards to mental health policy through review of relevant literature.AimsTo explore the basic implications of the economic crisis from a health policy perspective, reporting constraints and opportunities.MethodsA narrative review in PubMed/Medline along with a hand search in selected Greek biomedical journals was undertaken, relevant to mental health policy.ResultsGreece is among the OECD countries with high health expenditure as a percentage of Gross Domestic Product (9.7% of GDP in 2008) but it doesn’t have a specified budget for mental health and is mostly depended in out-of-pocket expenditure (48%). The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management and poor incentives in the public sector. The lack of cost-effectiveness and the informal payments comprise a major source of inequity and inefficiency. Uneven regional distribution of psychiatrists exists and rural areas are mostly uncovered by mental health care facilities, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system.ConclusionsThe core problem with mental health services in Greece is the shrinking budget with poor financial administration consistent with inadequate implementation of mental health policy. A clear authority with defined responsibility for overall mental health policy and budgetary matters is needed.

scholarly journals Validity and reliability of Korean version Competency Assessment Tool-Mental Health

2020 ◽  
Vol 7 (2) ◽  
pp. 143-152
Author(s):  
Hyun Mee Cho ◽  
Jeong Won Han ◽  
Eun Joung Choi ◽  
Hyo Eun Jeong ◽  
Bo Ram Hong ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Internal Consistency ◽  
Assessment Tool ◽  
Reliability And Validity ◽  
Basic Data ◽  
Measurement Tool ◽  
Competency Assessment ◽  
Validity And Reliability

AbstractObjectiveTo establish basic data for identifying the level of mental health care competency of general nurses through verification of the reliability and validity of Competency Assessment Tool-Mental Health in the development of a measurement tool for mental health care competency in Korea.MethodsThis study was conducted on nurses working at general wards, excluding those working at the Department of Psychiatry, in five hospitals with 200 beds or more located in Korea. Content, construct, concurrent validity, and internal consistency of the measurement were confirmed.ResultsAs a result of the construct validity, the section on importance of skills and knowledge for mental health care had 21 items, whereas the section on benefits of additional education had 22 items. The internal consistency of measurement was confirmed as follows: Cronbach's α = 0.96 for the section on importance and 0.96 for the section on benefits section.ConclusionsThis study verified the high validity and reliability of the tool in assessing the mental health care competency of nurses, and it is believed to be significant as basic data for enhancing such competency.

scholarly journals Realist Evaluation of the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care (EURIPIDES) in England: study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (6) ◽  
pp. e021013 ◽  
Author(s):  
Scott Weich ◽  
Sarah-Jane Hannah Fenton ◽  
Kamaldeep Bhui ◽  
Sophie Staniszewska ◽  
Jason Madan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Patient Experience ◽  
Study Protocol ◽  
Realist Evaluation ◽  
Inpatient Mental Health

Daily ward process in inpatient mental health care

2019 ◽  
pp. 187-192
Author(s):  
Katalin Walsby ◽  
Caroline Attard
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Clinical Care ◽  
Therapeutic Relationships ◽  
Inpatient Mental Health ◽  
Safe Environments

This chapter describes regular daily processes within the inpatient mental health ward that form the backbone of the ward’s functioning and underpin the ability of wards to provide therapeutic and safe environments. Precisely because acute inpatient wards can be unpredictable, with changing circumstances generating unremitting challenges to patients, carers, and staff, these daily processes, such as handover, medication, and mealtimes, are crucial to help create a sense of structure as well as safe clinical care. These processes must be followed if inpatient psychiatric wards are going to be able to provide an environment that allows the development of enabling and therapeutic relationships for patients, carers, and staff themselves.

scholarly journals Social care: an essential aspect of mental health rehabilitation services

2018 ◽  
Vol 28 (1) ◽  
pp. 4-8 ◽  
Author(s):  
T. J. Craig
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Care ◽  
Vital Role ◽  
Rehabilitation Services ◽  
Service Users ◽  
Personal Recovery ◽  
Social Interventions ◽  
The Individual

AbstractThis study is aimed at the importance of social care in rehabilitation. A brief overview of the social care theme is used as the methodology. There is a tension in mental health care between biological and psychological treatments that focus on deficits at the individual level (symptoms, disabilities) and social interventions that try to address local inequalities and barriers in order to improve access for service users to ordinary housing, employment and leisure opportunities. The history of mental health care tells us that social care is often underfunded and too easily dismissed as not the business of health care. But too much emphasis on a health model of individual deficits is a slippery slope to institutionalisation by way of therapeutic nihilism. Rehabilitation services follow the biopsychosocial model but with a shift in emphasis, recognising the vital role played by social interventions in improving the functional outcomes that matter to service users including access to housing, occupation, leisure facilities and the support of family and friends. In conclusion, rehabilitation is framed within a model of personal recovery in which the target of intervention is to boost hope and help the individual find a meaning to life, living well regardless of enduring symptoms.

scholarly journals The familiar stranger of mental health

2020 ◽  
Vol 15 (4) ◽  
pp. 237-247
Author(s):  
Matthew Sydney Long
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Facility ◽  
Health Care Professionals ◽  
Service User ◽  
Health Care Facilities ◽  
Mental Health Facility ◽  
Content Type ◽  
The Impact

Purpose This paper aims to contribute to the debate about the closure of institutional mental health-care facilities, from an experiential perspective of a former mental health inpatient, ongoing service user and campaigner for retention of such facilities. It argues that auto-ethnographic accounts of mental illness by those with multiple social identities can have a greater role in terms of future training of mental health-care professionals. Design/methodology/approach The paper offers an experiential account of the impact of mental health facility bed closures as a patient admitted to institutional mental health facilities; as a mental health campaigner, fighting for the provision of both places of safety and “safe space” within his own local community; and as an ongoing service user. The research is in the interpretivist tradition of social science in taking an auto-ethnographical methodological stance. Findings This paper is underpinned by two key theoretical notions. Firstly, Stuart Hall’s concept of the Familiar Stranger (2017) is used to explore the tensions of self-identity as the author SHIFTS uncomfortably between his three-fold statuses. Secondly, the notion of “ontological insecurity” offered by Giddens (1991) is used with the paper exploring the paradox that admission to a mental health facility so-called “place of safety” is in fact itself a disorientating experience for both patient and carer(s). Research limitations/implications No positivistic claims to reliability, representativeness or generalisability can be made. It is the authenticity of the account which the reader feels should be afforded primacy in terms of its original contribution to knowledge. Practical implications This paper should have practical use for those tasked with developing educational and training curriculums for professionals across the mental health-care sector. Social implications This paper implicitly assesses the political wisdom of the policy of mental health bed closures within the wider context of the deinstitutionalisation movement. Originality/value This paper is underpinned by original experiential accounts from the author as patient, campaigner for places of safety and onging service-user of mental health care provision.

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