Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

BACKGROUND Symptoms of mental illness are often triggered by stress, and individuals with mental illness are sensitive to these effects. The development of mobile health (mHealth) devices allows continuous recording of biometrics associated with activity, sleep, and arousal. Deviations in these measures could indicate a stressed state requiring early intervention. This paper describes a protocol for integrating an mHealth device into a community mental health team to enhance management of severe mental illness in young adults. OBJECTIVE The aim of this study is to examine (1) whether an mHealth device integrated into a community mental health team can improve outcomes for young adults with severe mental illness and (2) whether the device detects periods of mental health versus deterioration. METHODS This study examines whether physiological information from an mHealth device prevents mental deterioration when shared with the participant and clinical team versus with the participant alone. A randomized controlled trial (RCT) will allocate 126 young adults from community mental health services for 6 months to standard case management combined with an integrated mHealth device (ie, physiological information is viewed by both participant and case manager: unWIRED intervention) or an unintegrated mHealth device (ie, participant alone self-monitors: control). Participants will wear the Empatica Embrace2 device, which continuously records electrodermal activity and actigraphy (ie, rest and activity). The study also examines whether the Embrace2 can detect periods of mental health versus deterioration. A variety of measurements will be taken, including physiological data from the Embrace2; participant and case manager self-report regarding symptoms, functioning, and quality of life; chart reviews; and ecological momentary assessments of stress in real time. Changes in each participant’s Clinical Global Impression Scale scores will be assessed by blinded raters as the primary outcome. In addition, participants and case managers will provide qualitative data regarding their experience with the integrated mHealth device, which will be thematically analyzed. RESULTS The study has received ethical approval from the Western Sydney Local Health District Human Research Ethics Committee. It is due to start in October 2020 and conclude in October 2022. CONCLUSIONS The RCT will provide insight as to whether an integrated mHealth device enables case managers and participants to pre-emptively manage early warning signs and prevent relapse. We anticipate that unWIRED will enhance early intervention by improving detection of stress and allowing case managers and patients to better engage and respond to symptoms. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000642987; https://www.anzctr.org.au/ACTRN12620000642987.aspx INTERNATIONAL REGISTERED REPORT PRR1-10.2196/19510

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Community mental health team management in severe mental illness: A systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.178.6.497 ◽

2001 ◽

Vol 178 (6) ◽

pp. 497-502 ◽

Cited By ~ 70

Author(s):

Shaeda Simmonds ◽

Jeremy Coid ◽

Philip Joseph ◽

Sarah Marriott ◽

Petertyrer

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Illness ◽

Community Mental Health ◽

Severe Mental Illness ◽

Odds Ratio ◽

Team Management ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team

BackgroundCommunity mental health teams are now generally recommended for the management of severe mental illness but a comparative evaluation of their effectiveness is lacking.AimsTo assess the benefits of community mental health team management in severe mental illness.MethodA systematic review was conducted of community mental health team management compared with other standard approaches.ResultsCommunity mental health team management is associated with fewer deaths by suicide and in suspicious circumstances (odds ratio=0.32, 95% CI 0.09–1.12), less dissatisfaction with care (odds ratio=0.34, 95% CI 0.2–0.59) and fewer drop-outs (odds ratio=0.61, 95% CI 0.45–0.83). Duration of in-patient psychiatric treatment is shorter with community team management and costs of care are less, but there are no gains in clinical symptomatology or social functioning.ConclusionsCommunity mental health team management is superior to standard care in promoting greater acceptance of treatment, and may also reduce hospital admission and avoid deaths by suicide. This model of care is effective and deserves encouragement.

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Integrating a Mobile Health Device Into a Community Youth Mental Health Team to Manage Severe Mental Illness: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/19510 ◽

2020 ◽

Vol 9 (11) ◽

pp. e19510

Author(s):

Simon Byrne ◽

Beth Kotze ◽

Fabio Ramos ◽

Achim Casties ◽

Jean Starling ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Young Adults ◽

Community Mental Health ◽

Severe Mental Illness ◽

Controlled Trial ◽

Case Manager ◽

Case Managers ◽

Mental Health Team ◽

Health Team

Background Symptoms of mental illness are often triggered by stress, and individuals with mental illness are sensitive to these effects. The development of mobile health (mHealth) devices allows continuous recording of biometrics associated with activity, sleep, and arousal. Deviations in these measures could indicate a stressed state requiring early intervention. This paper describes a protocol for integrating an mHealth device into a community mental health team to enhance management of severe mental illness in young adults. Objective The aim of this study is to examine (1) whether an mHealth device integrated into a community mental health team can improve outcomes for young adults with severe mental illness and (2) whether the device detects periods of mental health versus deterioration. Methods This study examines whether physiological information from an mHealth device prevents mental deterioration when shared with the participant and clinical team versus with the participant alone. A randomized controlled trial (RCT) will allocate 126 young adults from community mental health services for 6 months to standard case management combined with an integrated mHealth device (ie, physiological information is viewed by both participant and case manager: unWIRED intervention) or an unintegrated mHealth device (ie, participant alone self-monitors: control). Participants will wear the Empatica Embrace2 device, which continuously records electrodermal activity and actigraphy (ie, rest and activity). The study also examines whether the Embrace2 can detect periods of mental health versus deterioration. A variety of measurements will be taken, including physiological data from the Embrace2; participant and case manager self-report regarding symptoms, functioning, and quality of life; chart reviews; and ecological momentary assessments of stress in real time. Changes in each participant’s Clinical Global Impression Scale scores will be assessed by blinded raters as the primary outcome. In addition, participants and case managers will provide qualitative data regarding their experience with the integrated mHealth device, which will be thematically analyzed. Results The study has received ethical approval from the Western Sydney Local Health District Human Research Ethics Committee. It is due to start in October 2020 and conclude in October 2022. Conclusions The RCT will provide insight as to whether an integrated mHealth device enables case managers and participants to pre-emptively manage early warning signs and prevent relapse. We anticipate that unWIRED will enhance early intervention by improving detection of stress and allowing case managers and patients to better engage and respond to symptoms. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000642987; https://www.anzctr.org.au/ACTRN12620000642987.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/19510

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Capacity to Choose Homelessness and Assessment of the Need for Guardianship

GeroPsych ◽

10.1024/1662-9647/a000122 ◽

2015 ◽

Vol 28 (3) ◽

pp. 109-112

Author(s):

Anne P. F. Wand ◽

Carmelle Peisah ◽

Karen L. Hunter

Keyword(s):

Mental Health ◽

Mental Illness ◽

Cognitive Aging ◽

Legal Issues ◽

Psychiatric Admission ◽

Mental Health Team ◽

Health Team ◽

People With Mental Illness ◽

Ethical And Legal Issues ◽

Family Consent

Abstract. A 77-year-old woman with schizoaffective disorder and mild cognitive impairment, who had been homeless for much of her life, had been placed against her wishes in a locked dementia-specific hostel following a psychiatric admission for delirium. This had occurred without a formal coercive accommodation guardianship order, but with family consent. The patient was distressed by the placement, frequently expressing the wish to leave and attempting to escape. The mental health team assessed her capacity to decide where she should live. Ethical and legal issues raised by the case are presented with relevance to the burgeoning global advocacy for the autonomous rights of people with mental illness and cognitive aging shared across jurisdictions and common to many human rights frameworks.

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The importance of service level measures for mental health policy

Epidemiologia e psichiatria sociale Monograph Supplement ◽

10.1017/s1827433100000988 ◽

1997 ◽

Vol 6 (S1) ◽

pp. 229-237 ◽

Cited By ~ 1

Author(s):

Rachel Jenkins ◽

Gyles Glover

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health Policy ◽

Community Mental Health ◽

Health Services ◽

Mission Statement ◽

Mental Health Policy ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team

The policy of any organisation is a setting out of the purposes for which it exists - its mission statement. Governments spend money on mental health services and therefore need a coherent mission statement for the use and goals to which that money is put. Moreover, the consequences of mental illness pervade all aspects of a nation's existence. Therefore a mission statement is needed to tackle mental illness and its consequences, not only by developing and using specialist mental health services to best effect, but also by using other relevant organisations as appropriate.Mental health policy is formulated at all levels from the community mental health team to the national government and thence to the World Health Organisation and the United Nations. Indeed national and international mental health policies have generally been led by local innovative best clinical practice. At local level, the policy of a community mental health team will identify the types of patients to which it seeks to provide a service, the channels through which referrals will be accepted, the type and nature of assessment and decision making about consequent interventions which will be used and a range of quality standards within which it will seek to operate. It may set out a set of desired goals in terms of the improvement in the health status of clients and the degree of consumer satisfaction it seeks to achieve. Some adverse consequences may be set out. For example, it may seek to minimise readmissions to hospital within a specified period of time or the frequency of violent or self-destructive behaviour on behalf of its clients.

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The care programme approach

Psychiatric Bulletin ◽

10.1192/pb.20.9.550 ◽

1996 ◽

Vol 20 (9) ◽

pp. 550-552 ◽

Cited By ~ 1

Author(s):

J. S. Jamieson

Keyword(s):

Mental Health ◽

Mental Illness ◽

Inner City ◽

Serious Mental Illness ◽

Continuing Care ◽

Community Mental Health Team ◽

Care Programme ◽

Mental Health Team ◽

Health Team ◽

High Level

The CPA encourages good psychiatric practice in the continuing care in the community of people who suffer with serious mental illness. The tiered CPA has recently been proposed with a view to channel resources towards those patients who are most in need. This study assesses whether the CPA is used appropriately and effectively among patients discharged in an inner city sector where there is a high level of serious mental illness. The results suggest that it is feasible provided there is an adequately developed community mental health team.

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Evaluation of a client held record introduced by a community mental health team

Psychiatric Bulletin ◽

10.1192/pb.21.12.757 ◽

1997 ◽

Vol 21 (12) ◽

pp. 757-759 ◽

Cited By ~ 7

Author(s):

Anna Stafford ◽

Richard Laugharne

Keyword(s):

Mental Health ◽

Mental Illness ◽

Community Mental Health ◽

Patient Involvement ◽

Community Mental Health Team ◽

Mental Health Team ◽

Health Team

A client held record for patients with long-term mental illness was introduced by a community mental health team in east London. The record was evaluated by asking the opinions of 45 patients and examining how their client record had been used. Over 80% of the patients found the record and the information it contained useful, 74% of contacts were recorded in the booklet and the client held record had begun to be used by many professionals for purposes other than appointments and medication. A client held record can increase patient involvement in care and help communication between professionals.

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Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization

The Canadian Journal of Psychiatry ◽

10.1177/0706743717752881 ◽

2018 ◽

Vol 63 (7) ◽

pp. 492-500 ◽

Cited By ~ 1

Author(s):

David Rudoler ◽

Claire de Oliveira ◽

Binu Jacob ◽

Melonie Hopkins ◽

Paul Kurdyak

Keyword(s):

Mental Health ◽

Mental Illness ◽

Cost Saving ◽

Cost Analysis ◽

Severe Mental Illness ◽

Inpatient Care ◽

Cost Savings ◽

Support Housing ◽

High Support

Objective: The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. Method: The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. Results: The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. Conclusions: This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

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Community psychiatry's achievements

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000560 ◽

2014 ◽

Vol 23 (4) ◽

pp. 337-344 ◽

Cited By ~ 5

Author(s):

T. Burns

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Community Psychiatry ◽

Psychosocial Interventions ◽

Community Mental Health Team ◽

Pattern Of Care ◽

Mental Health Team ◽

Health Team ◽

Developed World

Mental health care in the second half of the 20th century in much of the developed world has been dominated by the move out from large asylums. Both in response to this move and to make it possible, a pattern of care has evolved which is most commonly referred to as ‘Community Psychiatry’. This narrative review describes this process, from local experimentation into the current era of evidence-based mental health care. It focuses on three main areas of this development: (i) the reprovision of care for those discharged during deinstitutionalisation; (ii) the evolution and evaluation of its characteristic feature the Community Mental Health Team; and (iii) the increasing sophistication of psychosocial interventions developed to support patients. It finishes with an overview of some current challenges.

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