scholarly journals Examining equity in the utilisation of psychiatric inpatient care among patients with severe mental illness (SMI) in Ontario, Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Claire de Oliveira ◽  
Joyce Mason ◽  
Rowena Jacobs
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Inpatient Care ◽  
Psychiatric Inpatient ◽  
Ordinary Least Squares ◽  
Sensitivity Analyses ◽  
Psychiatric Admissions ◽  
Economic Equity ◽  
Over Time ◽  
Deprived Areas

Abstract Background Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time. Methods We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model. Results We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time. Conclusions Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.

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

2018 ◽  
Vol 63 (7) ◽  
pp. 492-500 ◽  
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.

Reducing hospitalisation among people living with severe mental illness

2016 ◽  
Vol 40 (2) ◽  
pp. 124 ◽  
Author(s):  
Shannon McDermott ◽  
Jasmine Bruce ◽  
Kristy Muir ◽  
Ioana Ramia ◽  
Karen R. Fisher ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Small Sample ◽  
Supported Housing ◽  
Health Records ◽  
Individual Level ◽  
Over Time

Objective People with severe mental illness have high rates of hospitalisation. The present study examined the role that permanent housing and recovery-oriented support can play in reducing the number and length of psychiatric hospital admissions for people with severe mental illness. Methods The study examined de-identified, individual-level health records of 197 people involved in the New South Wales Mental Health Housing and Accommodation Support Initiative (HASI) to compare changes in hospitalisation over a continuous 4-year period. Results On average, HASI consumers experienced significant reductions in the number of psychiatric hospital admissions and length of stay after entering the HASI program, and these reductions were sustained over the first 2 years in HASI. Male consumers and consumers under 45 years of age experienced the largest reductions in the number and length of hospital admissions. Conclusions The findings of the present study add support to the hypothesis that supported housing and recovery-oriented support can be effective approaches to reducing hospital admissions for people with chronic mental illness, and that these changes can be sustained over time. What is known about this topic? People living with severe mental illness are heavy users of health and hospitalisation services. Research into the effects of partnership programs on preventing unnecessary admissions is limited because of short periods of comparison and small sample sizes. What does this paper add? The present study extends previous research by analysing de-identified individual-level health records over a continuous 4-year period and showing that reductions in hospitalisation among people with severe mental illness can be sustained over time. What are the implications for practitioners? These findings provide further evidence that community-based recovery-oriented supported housing programs can assist consumers to manage their mental health and avoid hospital admissions. Although the provision of recovery-oriented community services requires an investment in community mental health, the reduction in consumers’ use of hospital services makes this investment worthwhile.

Factors associated with referrals to high security forensic services among people with severe mental illness and receiving inpatient care in prison

2019 ◽  
Vol 62 ◽  
pp. 90-94 ◽  
Author(s):  
Enrico Capuzzi ◽  
Elena Pini ◽  
Maria Rosaria Malerba ◽  
Francesca Cova ◽  
Annamaria Lax ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Inpatient Care ◽  
Factors Associated ◽  
High Security

scholarly journals Participation in medical decision-making across Europe: An international longitudinal multicenter study

2016 ◽  
Vol 35 ◽  
pp. 39-46 ◽  
Author(s):  
A. Bär Deucher ◽  
MP Hengartner ◽  
W. Kawohl ◽  
J. Konrad ◽  
B. Puschner ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Medical Decision Making ◽  
Patient Characteristics ◽  
Medical Decision ◽  
Research Attention ◽  
National Differences ◽  
Participation In Decision Making ◽  
Over Time

AbstractBackgroundThe purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries.MethodsThe data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations.ResultsWe found large cross-national differences in patients’ desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P < 0.001). Averaged over time and independent of patient characteristics, London (mean = 2.27), Ulm (mean = 2.13) and Zurich (mean = 2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean = 1.97), where scores were in turn significantly higher than in Debrecen (mean = 1.56). The lowest scores were reported in Naples (mean = 1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b = 0.23) and decreased in Naples (b = −0.14). In all other centers, values remained stable.ConclusionsThis study demonstrates that patients’ desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.

Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study

2016 ◽  
Vol 51 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Adrian H Heald ◽  
Julie L Martin ◽  
Tony Payton ◽  
Luma Khalid ◽  
Simon G Anderson ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Mental Illness ◽  
General Practice ◽  
Blood Glucose ◽  
Severe Mental Illness ◽  
Body Mass ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Fasting Blood Glucose ◽  
Over Time

Background: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. Objective: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. Methods: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. Results: Baseline body mass index was 28.6 kg/m2 increasing to 31.0 at 10-year follow-up ( r2 = 0.84; p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r2 = 0.48; p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r2 = 0.54; p < 0.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age ( p = 0.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9 mmol/L ( r2 = 0.88; p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r2 = 0.94; p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13]; p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55); p = 0.009) was independently associated with an increased risk of having type 2 diabetes. Conclusion: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

scholarly journals Longitudinal Changes in Functioning and Support After Initial Survey for Individuals With Severe Mental Illness

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 94-95
Author(s):  
Deborah Finkel ◽  
Per Bulöw ◽  
Pia Bulöw ◽  
Cristina Joy Torgé ◽  
Monika Wilińska ◽  
...  
Keyword(s):  
Social Support ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Support Services ◽  
Compulsory Education ◽  
Primary Diagnosis ◽  
Annual Data ◽  
Term Care ◽  
Social Support Services ◽  
Over Time

Abstract After the Swedish Mental Health Care reform was enacted in 1995, many individuals with severe mental illness were released from long-term care institutions. As a result, they had new living and support situations. Following 236 individuals over time supported investigation of the effectiveness of social support services in caring for these individuals. Surveys were conducted in 1996, 2001, 2006, and 2011 and annual data were available from national registries. Primary diagnosis was psychosis (over 60%); depression was the second highest diagnosis (20%). Mean age in 1996 was 60.8 (range = 45 to 86) and 47% of the sample were women. Only 36% of the group had more than nine-year compulsory education. Compared with other groups in the larger study, this group was more likely to have never married (66%) and 18% had accumulated more than 10 years in an institution over their lifetime (mean = 6 years). Even after correcting for age, functioning as measured by the Global Assessment of Functioning and a 9-item measure assessing hygiene, economy, food preparation, etc. declined over time. As a result, although 49% were living independently (with or without support) at the first wave, only 34% were doing so at the last wave; by 2011 66% were living in a special home or institution. Examination of longitudinal trends in income indicated that disposable income and total income from all sources was constant between 1990 and 1995 but increased significantly over time after reform was enacted. Overall, results suggest mixed success of social support services.

scholarly journals Psychological Distress, Coping and Perceived Social Support Among Partners of Women with Postpartum Onset Severe Mental Illness (SMI) Admitted to a Mother–Baby Unit

2020 ◽  
Vol 42 (6) ◽  
pp. 535-539
Author(s):  
PC Pradeepkumar ◽  
Ameer Hamza ◽  
G Ragesh ◽  
Sundarnag Ganjekar ◽  
Harish Thippeswamy ◽  
...  
Keyword(s):  
Social Support ◽  
Mental Illness ◽  
Psychological Distress ◽  
Severe Mental Illness ◽  
Perceived Social Support ◽  
Psychiatric Inpatient ◽  
Cross Sectional ◽  
Brief Cope ◽  
Psychological Distress Scale ◽  
Distress Scale

Background: The presence of a severe mental illness in the mother during the postpartum period may impact the whole family and specifically have an effect on the health of the spouse. The current study aimed to assess psychological distress, coping, and perceived social support of spouses of women with postpartum onset severe mental illness. Methodology: A cross-sectional descriptive research design was used, and 30 spouses of the women admitted to the mother–baby unit (MBU) for psychiatric inpatient care were included in the study. The assessments included sociodemographic details, Kessler psychological distress scale (K10), brief coping orientation to problems experienced scale (brief COPE), and Zimets’ multidimensional scale of perceived social support. Results: Around 50% of the spouses experienced severe psychological distress. Nearly 40% of spouses reported poor coping and 56.7% of spouses had moderate social support from family and friends. Conclusion: The findings indicate the need to address distress and coping in spouses of women with postpartum onset SMI.

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