The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

2008 ◽  
Vol 17 (4) ◽  
pp. 358-368 ◽  
Author(s):  
Mirella Ruggeri ◽  
Antonio Lora ◽  
Domenico Semisa
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Guideline Implementation ◽  
Specific Treatment ◽  
Care Process ◽  
First Episode ◽  
Routine Practice ◽  
Nice Guidelines ◽  
Illness Onset

SUMMARYAims– To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs.Methods– The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management.Results– The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process.Conclusions– The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.Declaration of Interest: None.

Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium?

2008 ◽  
Vol 17 (4) ◽  
pp. 270-277 ◽  
Author(s):  
Mirella Ruggeri
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Potential Role ◽  
Scientific Evidence ◽  
Guideline Implementation ◽  
Routine Practice ◽  
Daily Work ◽  
Italian Context ◽  
Key Aspects

SUMMARYThis paper discusses some key aspects of the debate on the difficulties of incorporating scientific evidence into the daily work of clinicians in mental health services (MHS). It highlights the topics of: the utility of guidelines in this field, the ethical principles that should guide their utilisation, their limitations, obstacles impeding the diffusion of guidelines in psychiatry, and strategies that can be useful for overcoming the barriers to guideline implementation. The SIEP-DIRECT's ((DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) Project's potential role in fostering this advancement is discussed in detail. This Project developed a set of 103 indicators that operationalised the NICE clinical guidelines for schizophrenia recommendations and tested them in 19 MHS in Italy. A multi-step design was used to assess recommendation and indicator acceptability in the Italian context; provide an assessment of any current discrepancies between routine practice and guideline recommendations in the treatment of schizophrenia; and understand the reasons for any discrepancies that might emerge. This process, moreover, was instrumental in keeping the debate arising during conduction of this Project far from the excesses of hostility - and excesses of “bright-eyed enthusiasm” - that frequently influence discussion on topic. This Project therefore showed potential to serve in the search for a happy medium, that can facilitate the pursuit of a fundamental advancement in guideline implementation in mental health services.Declaration of Interest: None.

The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence

2008 ◽  
Vol 17 (4) ◽  
pp. 291-304 ◽  
Author(s):  
Domenico Semisa ◽  
Antonio Lasalvia ◽  
Maurizio Miceli ◽  
Rosa Bruna Dall'Agnola ◽  
Cristina Pucci ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Focus Groups ◽  
Routine Practice ◽  
Organizational Models ◽  
Nice Guidelines ◽  
Patient Organizations ◽  
Cognitive Behavioural ◽  
Traditional Organization

SUMMARYAims– This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT's. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. Methods - In each of the 19 mental health departments or psychiatric services participating in the Project there were organized “multidisciplinary” focus groups and “specialistic” focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category.Results– Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or theassertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable.Conclusions– In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.Declaration of Interest: None.

scholarly journals Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola S. Gray ◽  
Ann John ◽  
Aimee McKinnon ◽  
Stephanie Raybould ◽  
James Knowles ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Evaluation ◽  
Suicide Risk ◽  
Professional Judgment ◽  
Health Board ◽  
Safety Planning ◽  
Nice Guidelines ◽  
Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

Characteristics of Effective School-Based, Teacher-Delivered Mental Health Services for Children

2019 ◽  
Vol 30 (4) ◽  
pp. 422-432
Author(s):  
Sunyoung Park ◽  
Samantha Guz ◽  
Anao Zhang ◽  
S. Natasha Beretvas ◽  
Cynthia Franklin ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Meta Analysis ◽  
Specific Treatment ◽  
Externalizing Disorders ◽  
Effect Sizes ◽  
Independent Effect ◽  
School Based ◽  
Treatment Characteristics

Purpose: The increasing need for school-based mental health services has altered teachers’ involvement in mental health services. Methods: This study presents a meta-analysis from a previous systematic review to identify which study characteristics result in effective treatment outcomes. Specific treatment characteristics analyzed in this study include type of intervention, treatment modality, length of treatment, and type of measurement. Effect sizes were coded by internalizing and externalizing disorders, depending on the symptoms the corresponding treatments were intended to address. A final sample size included 9 independent effect sizes of internalizing behaviors and 21 effect sizes of externalizing behaviors. Results: Internalizing disorders, social skill interventions, classroom modalities, and medium treatment length were moderating treatment characteristics. No significant effects were found for externalizing disorders. Conclusions: These results further add to the research on teacher’s role in school-based mental health services and provide important information for social workers who work in schools.

WHAT DO PEOPLE WANT FROM SPECIALIST MENTAL HEALTH SERVICES AND CAN THIS BE MEASURED IN ROUTINE SERVICE SETTINGS?

2000 ◽  
Vol 28 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Paul Lelliott
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Media Coverage ◽  
Community Care ◽  
Public Image ◽  
Routine Practice ◽  
Service Users ◽  
Measurement Instruments ◽  
Routine Service

The level of public satisfaction with mental health services is low. This is evident in adverse media coverage and the Government's view that community care has failed. Some components of a comprehensive mental health service are in disrepair and others are missing altogether. Surveys of those who use services show that many are dissatisfied with the care they receive. One of the actions that services must take to improve their effectiveness, acceptability and public image is to understand better what people want from the services they use. Surveys of service users have identified what these issues are. It is now important that these factors are incorporated into measurement instruments that can be used in routine practice settings. This paper summarizes what service users have indicated that they want from services, lists the desirable attributes of instruments that might measure these factors, and gives brief descriptions of four instruments that meet some aspects of the specification.

scholarly journals Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors

2018 ◽  
Vol 5 (1) ◽  
pp. e20 ◽  
Author(s):  
Christiaan Vis ◽  
Mayke Mol ◽  
Annet Kleiboer ◽  
Leah Bührmann ◽  
Tracy Finch ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Mood Disorders ◽  
Routine Care ◽  
System Level ◽  
Routine Practice

Background Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients’ mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided.

scholarly journals COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Adam Whyte ◽  
Alastair Reid
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Health Services ◽  
Health Services ◽  
First Episode Psychosis ◽  
First Episode ◽  
Intervention Service ◽  
Number Of Patients ◽  
Episode Psychosis ◽  
The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

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