Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance

2020 ◽  
Vol 102 ◽  
pp. 103490 ◽  
Samantha Hartley ◽  
Jessica Raphael ◽  
Karina Lovell ◽  
Katherine Berry
2011 ◽  
Vol 20 (3) ◽  
pp. 239-243 ◽  
P. McCrone

Background:Investment in innovative mental health care services requires the use of scarce resources that could be used in alternative ways. Economic evaluation is essential to ensure that such an investment is appropriately compared with investment elsewhere.Method:A non-systematic review of mental health evaluations identifies key methodological issues pertaining to economic studies.Results:Economic evaluations require the measurement and combination of costs and outcomes, and clarity about how this measurement is undertaken is required. Regarding costs, important considerations relate to the perspective to be taken (e.g., health service or societal), method of measurement (patient self-report or use of databases) and valuation (actual costs, fees or expenditure). Decision makers frequently need to compare evidence both within and between clinical areas and therefore there is a tension between the use of condition specific and generic outcome measures. Quality-adjusted life years are frequently used in economic evaluations, but their appropriateness in mental health care studies is still debated.Conclusions:Economic evaluations in the area of mental health care are increasing in number and it is essential that researchers continue to develop and improve methods used to conduct such studies.

2013 ◽  
Vol 24 (1) ◽  
pp. 78-89 ◽  
J. Wolff ◽  
P. McCrone ◽  
L. Koeser ◽  
C. Normann ◽  
A. Patel

Aims.New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence.Methods.A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted.Results.The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site.Conclusions.Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.

2010 ◽  
Vol 40 (10) ◽  
pp. 1585-1597 ◽  
K. K. Anderson ◽  
R. Fuhrer ◽  
A. K. Malla

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

2020 ◽  
Vol 50 (8) ◽  
pp. 1241-1256
Marie E. Nicolini ◽  
Scott Y. H. Kim ◽  
Madison E. Churchill ◽  
Chris Gastmans

AbstractBackgroundEuthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.MethodsFollowing the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.ResultsWe included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.ConclusionsThe ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

2018 ◽  
Vol 29 (1) ◽  
pp. 107-123 ◽  
Robert Griffiths ◽  
Warren Mansell ◽  
Dawn Edge ◽  
Sara Tai

In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user–led when planning and delivering mental health care. Additional clinical and research implications are discussed.

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