Improving mental health service users’ with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study

Objective.Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop.Methods.A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada.Results.Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily.Conclusions and Implications for Practice.Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

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Should all community mental health teams be sectorised?

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2019.60 ◽

2020 ◽

Vol 37 (1) ◽

pp. 48-54

Author(s):

R. Vaughan ◽

K. Antczak ◽

L. Kowalewski ◽

L. Feeney

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Service ◽

Community Mental Health ◽

Health Service ◽

Health Service Delivery ◽

Community Mental Health Service ◽

Service Users ◽

Health Service Provision ◽

Catchment Areas

ObjectivesSectorised catchment areas have characterised Irish mental health service delivery since the devolution of institutional care. Unlike other catchment areas, the Cluain Mhuire Community Mental Health Service (CMCMHS) never sectorised. With the development of Community Health Networks (CHNs) and Primary Care Centres, the CMCMHS has come under renewed pressure for structural change. We aimed to consider the implications of these proposed changes on staff and service users.MethodWe obtained demographic information comparing the CHNs with respect to attendee numbers, new referrals and admissions over a 1- year period. Secondly, we conducted an anonymous survey seeking opinions on the proposals to switch to a sector-based model and/or specialist inpatient care.ResultsReferral and admission rates differed across CHNs, broadly consistent with populations. About 36% of staff and 33% of service users supported changing to a sector-based system. In the event of a sector-based system of care being implemented, 66% of service users felt that existing service users should remain under the care of their current team. There was little support among any group for the development of specialist inpatient teams.ConclusionsWe discuss the benefits and drawbacks of sectorisation of mental health service provision. Most patients did not want to change teams either as current service users or as re-referrals (indicating it will take a significant time to transition to a sector-based system). Without clear pathways towards integration with primary care teams, the advantages of sectorisation may not outweigh the challenges associated with its implementation.

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