Innovations in Mental Health Care Delivery

1992 ◽  
Vol 160 (5) ◽  
pp. 589-597 ◽  
Author(s):  
Isaac Marks
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Community Care ◽  
Clinical Audit ◽  
Care Delivery ◽  
Severe Depression ◽  
Cost Effective ◽  
Community Services ◽  
Self Help ◽  
Anxiety Depression

In serious mental illness (SMI) even good community care does not usually make a major impact on clinical or social function, but patients and relatives prefer community to hospital care, and it tends to be cheaper. Any gains are lost if the required community services are not resourced, coordinated, and maintained indefinitely. A few SMI patients continue to need asylum under one roof. CPNs see more anxiety/depression than SMI. Their patients come increasingly from GPs, and they tend to work in practices with less need. Their cost-effectiveness is uncertain, although nurse behaviour therapists are cost-effective in anxiety disorders in primary care. Such research is also needed into the work of other mental health professionals. Despite their effectiveness, there is a dearth of behaviour therapists among nurses and psychiatrists. Problem-orientated training is lacking for most professionals with most patients. Behavioural self-treatments have improved phobic disorders and non-severe depression in controlled studies. Gains were as great when self-treatment was guided by a computer or by a manual as by a clinician. Self-help can extend care delivery, with therapists acting as consultants. Computers can also aid clinical audit.

Preventing Suicide in Prisons, Part II

Crisis ◽  
2007 ◽  
Vol 28 (3) ◽  
pp. 122-130 ◽  
Author(s):  
Marc S. Daigle ◽  
Anasseril E. Daniel ◽  
Greg E. Dear ◽  
Patrick Frottier ◽  
Lindsay M. Hayes ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Prevention ◽  
Mental Health Professionals ◽  
Task Force ◽  
International Association ◽  
Correctional Officers ◽  
Community Services ◽  
Correctional Systems ◽  
Prevention Activities ◽  
Prison Systems

Abstract. The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

scholarly journals Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil

2007 ◽  
Vol 29 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Sérgio Baxter Andreoli ◽  
Naomar Almeida-Filho ◽  
Denise Martin ◽  
Mário Dinis M L Mateus ◽  
Jair de Jesus Mari
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Public Investment ◽  
Community Services ◽  
Free Access ◽  
Psychiatric Reform ◽  
Psychiatric Admissions ◽  
Reducing Costs ◽  
New Community ◽  
Psychiatric Beds

OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

scholarly journals La depresión: una realidad masculina

Enfoques ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 45
Author(s):  
Nubia Álvarez Vargas ◽  
Ángela Paola Ochoa Gaitán
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Severe Depression ◽  
Mild Depression ◽  
Male Population ◽  
Cross Sectional ◽  
Implementation Phase ◽  
Adult Men ◽  
Descriptive Approach ◽  
Cross Sectional Design

 Currently Depression is a serious mental health problem, which significantly affects the individuals; thus requires an appropriate psychological management. Numerous studies have been conducted around this problem which repeatedly shows the presence of depression in women more than in men. However, considering that in the male population has increased the risk of the disease, especially if you consider that has not produced a specific etiology of depression in the male population; making it difficult for mental health professionals make diagnoses and treatments. Thus, the present study aims to determine the existence of depression in male employees of an institution of higher education. The research corresponds to a non-experimental cross-sectional design, quantitative and descriptive approach. The non-random sample of intentional or convenience way consisted of 45 men. The instrument of data collection is known as CDH (Questionnaire depression for men) through which to assess depressive symptoms in adolescent and adult men. Partial results helped identify 44% no depression, 40% mild depression, 11% with moderate depression and 5% severe depression. The discussion and analysis of the results will be finalized on completion of the implementation phase. 

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

scholarly journals Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools

Autism ◽  
2020 ◽  
Vol 24 (4) ◽  
pp. 867-883 ◽  
Author(s):  
Sebastian B Gaigg ◽  
Paul E Flaxman ◽  
Gracie McLaven ◽  
Ritika Shah ◽  
Dermot M Bowler ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Well Being ◽  
Behaviour Therapy ◽  
Self Help ◽  
Online Tools ◽  
Cognitive Behaviour ◽  
Autistic Adults

Anxiety in autism is an important treatment target because of its consequences for quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomised controlled trial examined whether online cognitive behaviour therapy and mindfulness-based therapy self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme or a waitlist control group (n = 19). Primary outcome measures of anxiety, secondary outcome measures of broader well-being and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 mindfulness-based therapies, 9 cognitive behaviour therapies) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools. Lay abstract Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.

scholarly journals Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 420-426 ◽  
Author(s):  
Sue Tucker ◽  
Jane Hughes ◽  
David Jolley ◽  
Deborah Buck ◽  
Claire Hargreaves ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Care ◽  
Mental Health Problems ◽  
Cost Savings ◽  
Community Services ◽  
Nominal Group ◽  
Strategic Issues ◽  
Patient Groups ◽  
Balance Of Care ◽  
Alternative Settings

BackgroundResearch suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.AimsTo identify which individuals require what services, at what cost.MethodA ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.ResultsCommunity care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.ConclusionsThe findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.Declaration of interestNone.

scholarly journals Stay Foolish, Stay Fit: An Excursus on Strategies to Prevent Burnout of Mental Health Professionals

2017 ◽  
Vol 41 (S1) ◽  
pp. S63-S63
Author(s):  
S. Ferrari ◽  
G. Rioli
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Work Organization ◽  
Significant Risk ◽  
Cost Effective ◽  
Specific Work ◽  
Personal Efficacy ◽  
Burn Out ◽  
Healthy Life Style ◽  
Competing Interest

Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives.Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. Time schedules), infrastructures (eg. Parking places) or dynamics and human interactions, are also essential and effective.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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