scholarly journals Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucy Maconick ◽  
Luke Sheridan Rains ◽  
Rebecca Jones ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Geographical Variation ◽  
Ecological Study ◽  
Cross Sectional ◽  
Psychological Therapies ◽  
Access To Primary Care

Abstract Background There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. Methods This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. Results The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. Conclusions There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder.

scholarly journals Business as Un-usual: Access to mental health and primary care services for people with severe mental illness during the COVID-19 restrictions

2021 ◽  
Author(s):  
Elizabeth Newbronner ◽  
Panagiotis Spanakis ◽  
Ruth Wadman ◽  
Suzanne Crosland ◽  
Paul Heron ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Support ◽  
Health Support

Aims: To explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services. Materials and Methods: A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically. Results: 367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person. Discussion: Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

scholarly journals Improving mental health services in a local area — an exploratory study

2004 ◽  
Vol 28 (3) ◽  
pp. 292 ◽  
Author(s):  
Terry Buchan ◽  
Duncan P Boldy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Exploratory Study ◽  
Local Area ◽  
People With Mental Illness ◽  
Improved Model ◽  
Made In

The change in the focus of care for people with mental illness from hospital to community has been far from uniformly successful for a variety of reasons. A review of the development of mental health services suggests that the views of doctors and the responses of administrative systems are significant forces in shaping the development of services. This study explored the attitudes of general practitioners, psychiatrists and administrators, with a view to establishing areas of congruence in order to move towards an improved model of service delivery. Recommendations are made in the areas of primary care psychiatry, access, communication and education.

scholarly journals Family Planning for Women With Severe Mental Illness in Rural Ethiopia: A Qualitative Study

2020 ◽  
Author(s):  
Tigist Zerihun ◽  
Katherine Sorsdahl ◽  
Charlotte Hanlon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Family Planning ◽  
Mental Health Services ◽  
Qualitative Study ◽  
Health Services ◽  
Reproductive Age ◽  
Family Planning Services ◽  
Care Services

Abstract Background: Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI) there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences, unmet needs and preferences of women with SMI who reside in a predominantly rural area of Ethiopia Methods: A qualitative study design was used. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively on the basis of responses to a quantitative survey of current family planning utilization. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analyzed using the Framework Approach using Open Code qualitative data analysis software. Results: Participants reported pervasive effects of SMI upon the intimate relationships and sexual life of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. Conclusion: This study has provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.

scholarly journals Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario

2017 ◽  
Vol 63 (6) ◽  
pp. 378-386 ◽  
Author(s):  
Alyson L. Mahar ◽  
Alice B. Aiken ◽  
Heidi Cramm ◽  
Marlo Whitehead ◽  
Patti Groome ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Services ◽  
Retrospective Cohort ◽  
Care Physician ◽  
Health Related

Objective: A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. Method: This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health–related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. Results: The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health–related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health–related reason (5.1% had at least 1 ED visit). Conclusion: Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.

scholarly journals Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Siobhan Reilly ◽  
Catherine McCabe ◽  
Natalie Marchevsky ◽  
Maria Green ◽  
Linda Davies ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Medical Records ◽  
Secondary Care ◽  
Mental Healthcare ◽  
The Uk

Background There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. Aims This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. Method We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. Results The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. Conclusions The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.

scholarly journals Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis (Preprint)

2020 ◽  
Author(s):  
Adam Atherly ◽  
Eline Van Den Broek-Altenburg ◽  
Victoria Hart ◽  
Kelsey Gleason ◽  
Jan Carney
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Effects ◽  
Care Delivery ◽  
Preventive Services ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

BACKGROUND The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. OBJECTIVE This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. METHODS We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. RESULTS Deferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. CONCLUSIONS Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services.

scholarly journals Determinants of timely access to Specialized Mental Health Services and maintenance of a link with Primary Care: A cross-sectional study.

2021 ◽  
Author(s):  
Carlos Alberto dos Santos Treichel ◽  
Ioannis Bakolis ◽  
Rosana Teresa Onocko-Campos
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Waiting Times ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Timely Access ◽  
Specialized Mental Health

Abstract Background: Although it is known that several factors may influence the access to specialized care, the factors related to the maintenance of a link with Primary Care by patients who accessed Specialized Mental Health Services (SMHS) remain unknown. The aim of this study was to evaluate the determinants of timely access to SMHS and maintenance of a link with Primary Care. Methods: This is a cross-sectional study, conducted with 341 users of SMHS at outpatient and community level in a medium-sized city in Brazil. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators. Results: Among the factors associated with the study outcomes, those related to the organization of services and the movement between them were noteworthy. Patients referred by Primary Care were less likely to access specialized services in a timely manner (RR: 0.61; 95% CI: 0.40, 0.93). However, the referral of cases by Primary Care (RR: 1.38; 95% CI: 1.06, 1.79) and follow-up with visits by Community Health Agents (RR: 1.26; 95% CI: 1.04, 1.53) appeared to favor maintenance of the patient-Primary Care link. Conclusion: This study reinforces the idea that integration between Primary Care and SMHS should be strengthened, both to reduce waiting times for between-service referrals and benefit continuity of care.

scholarly journals Family planning for women with severe mental illness in rural Ethiopia: a qualitative study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tigist Zerihun ◽  
Katherine Sorsdahl ◽  
Charlotte Hanlon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Family Planning ◽  
Mental Health Services ◽  
Qualitative Study ◽  
Health Services ◽  
Reproductive Age ◽  
Family Planning Services ◽  
Care Services

Abstract Background Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI), there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences and preferences of women with SMI who reside in a predominantly rural area of Ethiopia. Methods A qualitative study was conducted. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively based on their responses to a quantitative survey of current family planning utilisation. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analysed thematically. Results Participants reported pervasive effects of SMI upon the intimate relationships and sexual lives of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally, and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. Conclusions This study provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.

scholarly journals Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Helle Wessel Andersson ◽  
Solfrid E. Lilleeng ◽  
Torleif Ruud ◽  
Solveig Osborg Ose
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Census Data ◽  
Current Treatment ◽  
Cross Sectional ◽  
Specialized Mental Health

Abstract Background Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes. Methods We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation. Results The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends. Conclusion Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.

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