scholarly journals Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study.

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Annette Sofie Davidsen ◽  
Johan Davidsen ◽  
Alexandra Brandt Ryborg Jønsson ◽  
Maria Haahr Nielsen ◽  
Pia Kürstein Kjellberg ◽  
...  
Keyword(s):  
Mental Illness ◽  
General Practice ◽  
Severe Mental Illness ◽  
Organizational Support ◽  
Interpretative Phenomenological Analysis ◽  
Symptom Control ◽  
Social Psychiatry ◽  
Treatment Team ◽  
Existential Approach ◽  
Health And Social Care

Abstract Background Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration. Method We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis. Results The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors. Conclusion Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.

scholarly journals The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
M. P. Rozing ◽  
A. Jønsson ◽  
R. Køster-Rasmussen ◽  
T. D. Due ◽  
J. Brodersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
General Practice ◽  
Severe Mental Illness ◽  
General Practitioners ◽  
Pilot Trial ◽  
Care Program ◽  
Coordinated Care ◽  
Educational Training

Abstract Background People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness. Methods The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period. Discussion If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or after revision, is considered feasible, a future, definitive trial to determine the effectiveness of the intervention in reducing mortality and improving quality of life in patients with SMI can take place. Successful implementation of the intervention would imply preliminary promise for addressing health inequities in patients with SMI. Trial registration The trial was registered in Clinical Trials as of November 5, 2020, with registration number NCT04618250. Protocol version: January 22, 2021; original version

scholarly journals 520 - Benefits of Assertive Community Treatment for Persons with Severe Mental Illness and Cancer

2021 ◽  
Vol 33 (S1) ◽  
pp. 69-69
Author(s):  
Monica Taylor-Desir
Keyword(s):  
Breast Cancer ◽  
Mental Illness ◽  
Cancer Treatment ◽  
Severe Mental Illness ◽  
Assertive Community Treatment ◽  
Community Treatment ◽  
Case Vignette ◽  
Treatment Team ◽  
Assertive Community Treatment Team

Breast cancer, the most commonly diagnosed cancer in women worldwide, is responsible for one in six cancer deaths (Sung, H. et al., 2021). Women with schizophrenia have an associated increased incidence of breast cancer compared to the general population (Grassi & Riba, 2020). Patients with severe mental illness are noted to have disparities in accessing and initiating cancer treatment especially among those who are older (Iglay et al., 2017). A case vignette will be presented to illustrate the care and interventions provided by an American Assertive Community Treatment team which fostered supportive treatment engagement and improved the quality of life for a patient that chose to forgo recommended cancer treatment. This presentation will highlight the essential nature of the Assertive Community Treatment team in supporting decisional capacity, facilitation of a patient’s grief and acknowledgement of one’s own mortality as well as incorporation of medical and palliative care. The attendee will appreciate the importance of the multidisciplinary approach for persons with chronic mental illness and co-morbid cancer diagnoses.

Psychosocial rehabilitation

2020 ◽  
pp. 229-242
Author(s):  
Mariam Ujeyl ◽  
Wulf Rössler
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Social Inclusion ◽  
Psychiatric Rehabilitation ◽  
Symptom Control ◽  
Psychosocial Rehabilitation ◽  
Models Of Care ◽  
Community Treatment ◽  
Mental Health Systems

Psychosocial rehabilitation (synonymously referred to as psychiatric rehabilitation) is a field and service within mental health systems that shifted the treatment focus from symptom control to social inclusion by functional recovery. It aims to help individuals with severe mental illness live in the community as independently as possible. Psychosocial rehabilitation (PR) developed in the 1970s, when psychiatric reform, including the process of deinstitutionalization, had already paved the way to more responsive and balanced provision of mental health care. This chapter outlines major developments in and obstacles to the reform in European and other high-income countries. It introduces the evolving principles of PR and presents evidence on important models of care, such as assertive community treatment (ACT) and individual placement and support (IPS), that share the objectives of PR to improve integration of people with severe mental illness into the labour market and society in general.

scholarly journals Running an assertive community treatment team

1999 ◽  
Vol 5 (5) ◽  
pp. 348-356 ◽  
Author(s):  
Tom Burns ◽  
Louise Guest
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Assertive Community Treatment ◽  
Coping Skills ◽  
Community Treatment ◽  
Treatment Team ◽  
Assertive Community Treatment Team ◽  
Mental Hospitals ◽  
The 1960S

In the 1960s, most people with severe mental illness were treated in large mental hospitals, receiving all their care under one roof, ensuring its continuity and accountability. Deinstitutionalisation resulted in discharge into the community, where care was fragmented between many agencies, making continuity and accountability very difficult. Countless individual programs were developed with few links between them. Not surprisingly, deinstitutionalised patients, in an unfamiliar environment and with poor coping skills to navigate services, did not receive the care they needed.

scholarly journals Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis

2015 ◽  
Vol 206 (4) ◽  
pp. 268-274 ◽  
Author(s):  
Amina Yesufu-Udechuku ◽  
Bronwyn Harrison ◽  
Evan Mayo-Wilson ◽  
Norman Young ◽  
Peter Woodhams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Psychological Distress ◽  
Severe Mental Illness ◽  
Mental Health Problems ◽  
Meta Analysis ◽  
First Episode ◽  
Post Intervention ◽  
Health And Social Care

BackgroundInformal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met.AimsTo determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden.MethodWe conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness).ResultsTwenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16, 95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD =–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD =–1.57, 95% CI −1.79 to −1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive.ConclusionsCarer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.

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