scholarly journals Cost drivers of inpatient mental health care: a systematic review

2013 ◽  
Vol 24 (1) ◽  
pp. 78-89 ◽  
Author(s):  
J. Wolff ◽  
P. McCrone ◽  
L. Koeser ◽  
C. Normann ◽  
A. Patel
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Related Factors ◽  
Inpatient Mental Health ◽  
Affective Symptoms

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.

scholarly journals Invisible Experts: A Systematic Review & Thematic Synthesis of Informal Carer Experiences of Inpatient Mental Health Care

2021 ◽  
Author(s):  
Nada Abou Sief ◽  
Lisa Wood ◽  
Nicola Morant
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Inpatient Care ◽  
Community Services ◽  
Informal Carer ◽  
Reference List ◽  
Thematic Synthesis ◽  
Inpatient Mental Health

Abstract Background: The negative impact of caregiving on carers’ physical and psychological wellbeing is well documented. Carers of mental health inpatients face additional burden, and report predominantly negative experiences of inpatient services. It remains unclear why, despite policies intended to improve inpatient experiences. A comprehensive review of carers’ inpatient experiences is needed to understand carer needs. As such, we aimed to conduct a systematic review and thematic synthesis of carer experiences of inpatient mental health care. Methods: We searched MEDLINE, PsycINFO, Embase and CINAHL for qualitative studies examining carer experiences of mental health inpatient care. Searches were supplemented by reference list screening and forward citation tracking of included studies. Results were synthesised using thematic synthesis. Our protocol was registered on PROSPERO (CRD42020197904) and our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Findings: 12 studies were included from 6 countries. Four themes were identified: the emotional journey of inpatient care, invisible experts, carer concerns about quality of care for their loved one and relationships and partnershipInterpretation: Greater attention must be paid to ensure carers are well-supported, well-informed, and included in care. More emphasis must be placed on fostering positive relationships between carers, service users and staff and in facilitating continuity of care across inpatient and community services to provide carers with a sense of security and predictability. Further research is needed to explore differences in experiences based on carer and service user characteristics and global context, alongside co-production with carers to develop and evaluate future guidelines and policies.

scholarly journals Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study

2020 ◽  
Vol 8 (21) ◽  
pp. 1-338
Author(s):  
Scott Weich ◽  
Sarah-Jane Fenton ◽  
Sophie Staniszewska ◽  
Alastair Canaway ◽  
David Crepaz-Keay ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Health Services ◽  
Mental Health Care ◽  
Patient Experience ◽  
Best Practice ◽  
Consensus Conference ◽  
Work Package ◽  
Inpatient Mental Health

Background All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur. Aims To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care. Design The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4. Setting The study was conducted in 57 NHS providers of inpatient mental health care in England. Participants In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference. Results The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these. Limitations The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data. Conclusions Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data. Future work Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice. Study registration The systematic review (work package 1) is registered as PROSPERO CRD42016033556. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.

scholarly journals Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health

10.2196/24245 ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. e24245
Author(s):  
Hanneke Kip ◽  
Jobke Wentzel ◽  
Saskia M Kelders
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Focus Groups ◽  
Phase 1 ◽  
Participatory Development ◽  
Project Team ◽  
Related Factors ◽  
Web Based ◽  
Blended Care

Background Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. Objective The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting—forensic mental health care—by means of participatory development with therapists. Methods The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. Results In phase 1, it became clear that the therapists’ main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. Conclusions The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed.

scholarly journals Psychological therapy for inpatients receiving acute mental health care: A systematic review and meta-analysis of controlled trials

2018 ◽  
Vol 57 (4) ◽  
pp. 453-472 ◽  
Author(s):  
Charlotte Paterson ◽  
Thanos Karatzias ◽  
Adele Dickson ◽  
Sean Harper ◽  
Nadine Dougall ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Meta Analysis ◽  
Psychological Therapy ◽  
Controlled Trials

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.

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