scholarly journals Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M.-J. Fleury ◽  
G. Grenier ◽  
L. Gentil ◽  
P. Roberge
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Family Medicine ◽  
Adolescent Psychiatry ◽  
Organizational Support ◽  
Service Providers ◽  
System Level ◽  
Youth Centers ◽  
Adult Psychiatry ◽  
Child Adolescent Psychiatry

Abstract Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations.

scholarly journals Co-designing Services for Youth With Mental Health Issues: Novel Elicitation Approaches

2019 ◽  
Vol 18 ◽  
pp. 160940691881624 ◽  
Author(s):  
Gillian Mulvale ◽  
Sandra Moll ◽  
Ashleigh Miatello ◽  
Louise Murray-Leung ◽  
Karlie Rogerson ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Thinking ◽  
Service Providers ◽  
Essential Elements ◽  
System Level ◽  
Mutual Understanding ◽  
Health Issues ◽  
Prototype Development ◽  
Mental Health Issues ◽  
Research Narrative

Experience-based co-design (EBCD) is an innovative, evidence-based approach to health and social system change based on principles of participatory action research, narrative and learning theory, and design thinking. Unique elicitation strategies such as experience mapping, trigger videos, and prototype development are used in EBCD to engage service users and service providers in a collaborative process of identifying touchpoints and solutions to system-level problems. In this article, we present findings from interviewing a purposeful sample of 18 participants (4 youth, 6 service providers, 6 family members, and 2 employers) across three co-design projects designed to address either mental health or employment services for youth (aged 16–24) with mental health issues in one urban center. Through interviewing participants, perceptions were explored relating to three elicitation techniques: creating experience maps, creating and viewing trigger videos, and co-designing visual “prototype” solutions. Analysis of participants’ comments indicated that these techniques can be powerful tools to foster mutual understanding and collaborative ideas, but they require a social, spatial, and temporal context that optimizes their value. A “safe space” is needed within which the essential elements of elicitation—building trust, finding voice, sharing perspectives, and creating a common vision—can occur. Three core, overlapping processes of co-design elicitation were identified: “building common perspectives,” “building mutual understanding,” and “building innovation.” We present a conceptual framework depicting the interplay of processes and elicitation techniques, essential to building mutual understanding and innovation during the EBCD process.

Evaluating models of working at the interface between mental health services and primary care

1997 ◽  
Vol 170 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Linda Gask ◽  
Bonnie Sibbald ◽  
Francis Creed
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Care Services ◽  
Service Providers ◽  
Psychiatric Nurses ◽  
Local Health ◽  
Care Services ◽  
Secondary Health Care

BackgroundThis paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.MethodMethodological problems relevant to evaluation of innovative models of working at the interface are discussed.ResultsAlthough there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.ConclusionStudies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

scholarly journals Impact of Interprofessional Care Conferences Across Primary Care and Mental Health Organizations on Family Medicine Resident Learning

2021 ◽  
Vol 53 (4) ◽  
pp. 289-294
Author(s):  
Keri D. Hager ◽  
Jen Nelson Albee ◽  
Carolyn O'Donnell ◽  
Sarah Jackson ◽  
Amelia King ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Family Medicine ◽  
Medication Safety ◽  
Safety Monitoring ◽  
Holistic Care ◽  
Interprofessional Care ◽  
Care Conference ◽  
Family Medicine Residents

Background and Objectives: Patients with severe mental illness often lack care coordination between primary care and mental health providers which can negatively impact patient outcomes. Team-based care is integral in the effective management of patients with multiple comorbidities, with the family physician central in coordinating holistic care. Family medicine residency programs must provide models of effective interprofessional collaboration and mental health treatment to prepare residents to navigate an evolving health care landscape. The objective of this study was to evaluate family medicine residents’ learning about providing holistic care with an interprofessional team and medication safety monitoring from the interprofessional cross-organizational care conference experience. Methods: To bridge care and cultivate the necessary skills, a family medicine clinic and mental health clinic implemented monthly interprofessional care conferences to coordinate care for their shared patients during 2019. Residents who participated in the care conference each (n=11) completed a retrospective pre/postsurvey (11/11=100% response rate) to gather perceptions of what they learned from the interprofessional care conference experience. Results: After participating in the care conference, all residents agreed they understood the elements that must be considered to provide holistic patient care, were confident conducting medication safety monitoring for their patients taking second-generation antipsychotics (eg, lipids, A1C, ECG), and agreed the care conference helped them develop a more comprehensive patient-centered care plan. Additionally, they all intend to work collaboratively across professions in the future. Conclusions: Interprofessional and cross-organizational care conferences create an authentic learning environment that enhances family medicine residents’ understanding and confidence in providing collaborative and holistic care for patients with severe and persistent mental illness.

scholarly journals Availability of mental health services at the primary care level in northern part of Nigeria: Service providers' and users' perspectives

2020 ◽  
Vol 36 (2) ◽  
pp. 157
Author(s):  
EmmanuelEjembi Anyebe ◽  
VictorO Olisah ◽  
SalehNgaski Garba ◽  
HassanHassan Murtala ◽  
Fatima Balarabe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Service Providers ◽  
Care Level ◽  
Primary Care Level

scholarly journals The Weathering Well App, A New Low Intensity Digital Mental Health Intervention for Australian Farmers: Formative Research

2021 ◽  
Author(s):  
Buaphrao Raphiphatthana ◽  
Michelle Sweet ◽  
Kylie Dingwall ◽  
Alistair MacDonald ◽  
Tricia Nagel
Keyword(s):  
Mental Health ◽  
Organizational Support ◽  
Mental Health Problems ◽  
Service Providers ◽  
Health Intervention ◽  
Successful Implementation ◽  
Mental Health Intervention ◽  
Farming Communities ◽  
Low Intensity ◽  
Usage Data

Abstract Background Australian farming communities demonstrate significant resilience in the face of many challenges, including drought, bushfires, and more recently COVID-19. Nevertheless, worries related to financial hardship, farm viability and productivity, and remoteness render the population vulnerable to mental health problems. Despite this vulnerability, people in these communities are unlikely to seek help from mental health services due to attitudes, service access and geographic barriers. A tailored, low intensity digital mental health intervention may provide an acceptable and appropriate early wellbeing intervention for the population and help bridge the mental health service gap. Objectives This study has three objectives: 1) to adapt an existing tablet-based, therapist-guided, low intensity digital mental health intervention to address the wellbeing needs of Australian farming communities (development of the Weathering Well app), 2) to adapt, deliver, and evaluate training in utilisation of the new app, and 3) to conduct preliminary analyses on app usage data during the 12-months post-app release. Methods An Expert Advisory Group, comprising graziers, growers, rural financial counsellors, rural and remote mental health clinicians, Information Technology (IT) experts, Western Queensland Primary Health Networks representatives, Peak Body representatives (New South Wales rice growers), and drought impacted Shire Council representatives, was established. A three-day co-design workshop facilitated by the research team followed by a series of member-checking and user-testing rounds led to release of the new app. Pre-existing training resources were adapted, and the revised training workshops were delivered to service providers working with remote and rural farming communities. Pre- and post-training evaluations and app usage data were analysed. Results The final Weathering Well app received approval for public release by all stakeholders in September 2019. Following training, participant scores suggested that the app was accessible, appropriate, and effective with increased perceived knowledge and confidence in app use post-training. Analysis of app usage data indicated good app engagement, providing additional preliminary evidence for feasibility and acceptability. Trainees indicated reservations in terms of successful implementation most notably the need for organizational support for use. Conclusions This study provides an example of an intervention tailored to context through collaborative co-design. The preliminary findings suggest high levels of acceptability, providing a good foundation for implementation, further app revision and exploration of effectiveness and sustainability.

Commissioning for health and community sector reform: perspectives on change from Victoria

2020 ◽  
Vol 26 (4) ◽  
pp. 332
Author(s):  
Kate Silburn ◽  
Virginia Lewis
Keyword(s):  
Mental Health ◽  
State Government ◽  
Service Providers ◽  
Community Support ◽  
Models Of Care ◽  
Community Services ◽  
System Level ◽  
Reform Process ◽  
Structured Interviews ◽  
Competitive Tendering

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.

Continuing the Debate on a Separate Adolescent Psychiatry

1997 ◽  
Vol 31 (4) ◽  
pp. 447-451 ◽  
Author(s):  
Peter Birleson ◽  
Ernest S.L. Luk
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Adolescent Psychiatry ◽  
Adolescent Mental Health ◽  
Epidemiological Studies ◽  
Service Planning ◽  
Mental Health Needs ◽  
Adult Psychiatry ◽  
History Of

Objective: This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry. Method: Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches. It goes on to explore the implications of a separate adolescent psychiatry for service delivery, including how current service boundaries and the training of psychiatrists might need to change. Results and Conclusions: An argument is mounted that psychiatrists should take a whole life perspective, rather than further fragment the specialty. In most Australian States, recent reviews of child and adolescent mental health services are likely to result in increased funding for services to adolescents. Adult psychiatry needs to attend more to the requirements of older adolescents, and greater collaboration is recommended between psychiatry services for children and adults. The authors argue for diversity of approaches, and consider that moves towards separate adolescent mental health services may not always be appropriate.

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