scholarly journals Integration of mental health care into primary care

2000 ◽  
Vol 176 (6) ◽  
pp. 581-588 ◽  
Author(s):  
D. Chisholm ◽  
S. James ◽  
K. Sekar ◽  
K. Kishore Kumar ◽  
R. Srinivasa Murthy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Low Income ◽  
Common Mental Disorder ◽  
Low Income Countries

BackgroundTargeting resources on cost-effective care strategies is important for the global mental health burden.AimsTo demonstrate cost–outcome methods in the evaluation of mental health care programmes in low-income countries.MethodFour rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.ResultsBetween 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.ConclusionEconomic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.

Depressions Plural

2017 ◽  
Author(s):  
K W M (Bill) Fulford ◽  
David Crepaz-Keay ◽  
Giovanni Stanghellini
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Personal Values ◽  
The Political ◽  
Medical Law ◽  
Isaiah Berlin ◽  
Political Philosopher

This chapter examines how values influence the heterogeneity of depression. The plurality of values is increasingly significant for contemporary person-centred mental health care with its emphasis on quality of life and development of self-manvnagement skills. Values-based practice is a partner with medical law invn working with the plurality of personal values. The chapter explains what values are, shows how the plurality of values influences the heterogeneity of depression at several levels, and provides an overview of values-based practice. It looks at the resources available for combining values-based practice with medical law in contemporary person-centred care and indicates some of the challenges this raises. It concludes with a brief reflection on these challenges understood as an instance of what the political philosopher Isaiah Berlin called the challenge of pluralism.

Primary Care Pediatrics and Child Psychopathology: A Review of Diagnostic, Treatment, and Referral Practices

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1044-1051 ◽  
Author(s):  
Elizabeth J. Costello
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Primary Care Providers ◽  
Health Problems ◽  
Group Practices ◽  
Primary Care Pediatricians

The quality of mental health care for children depends not only on specialist mental health services, but also on how effectively primary care providers identify, treat, and refer children with emotional and behavioral problems. Recent research has shown that primary care practitioners are the sole providers of mental health care to the majority of people with a mental disorder. For example, Regier et al1 calculated that in 1975 54.1% of persons with a mental disorder were treated only in a primary care or outpatient medical setting, with another 6% receiving care from both specialist mental health and primary care medical facilities. An additional 21.5% were not in treatment or received treatment from nonmedical agencies. If the data were extrapolated for all age groups, these rates would imply that only one child in five with a mental disorder is receiving specialist treatment, three are in the care of a pediatrician, and one is receiving no treatment. This would lead to the conclusion that pediatricians are, according to Regier et al,1 the de facto mental health service for most children in need of such care. It would lend support to the drive to increase pediatricians' awareness of, and training for, the mental health component of their work.2 In this paper, we review the published evidence as it applies to children. SCOPE This review includes the published studies of mental health problems diagnosed by primary care pediatricians, family practitioners, or pediatric nurse practitioners working in outpatient settings in the United States. These include private pediatric practices, group practices, health maintenance organizations (HMOs), and other types of prepaid group practices. The questions addressed are: (1) What proportion of the children seen by primary care pediatricians and their colleagues are diagnosed by them as having a mental disorder? (2) What proportion of children are referred for specialist evaluation and treatment? (3) What risk factors are associated with a higher probability of receiving a diagnosis of psychopathology? (4) How accurate are primary care pediatricians' diagnoses of mental health problems?

scholarly journals Challenges in Investigating the Effective Components of Feedback from Routine Outcome Monitoring (ROM) in Youth Mental Health Care

2020 ◽  
Author(s):  
Maartje A. M. S. van Sonsbeek ◽  
Giel J. M. Hutschemaekers ◽  
Jan W. Veerman ◽  
Ad Vermulst ◽  
Marloes Kleinjan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Symptom Severity ◽  
Youth Mental Health ◽  
Routine Outcome Monitoring ◽  
Effective Components ◽  
Outcome Monitoring

Abstract BackGround Studies on feedback in youth mental health care are scarce and implementation of feedback into clinical practice is problematic. Objective To investigate potentially effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care in the Netherlands through a three-arm, parallel-group, randomized controlled trial in which a literature-based, multi-faceted implementation strategy was used. Method Participants were randomly allocated to three conditions (basic feedback about symptoms and quality of life; basic feedback supplemented with clinical support tools; discussion of the feedback of the second condition with a colleague while following a standardized format for case consultation) using a block randomization procedure, stratified by location and participants’ age. The youth sample consisted of 225 participants (mean age = 15.08 years; 61.8% female) and the parent sample of 234 mothers and 54 fathers (mean age of children = 12.50 years; 47.2% female). Primary outcome was symptom severity. Secondary outcomes were quality of life and end-of-treatment variables. Additionally, we evaluated whether being Not On Track (NOT) moderated the association between condition and changes in symptom severity. Results No significant differences between conditions and no moderating effect of being NOT were found. This outcome can probably be attributed to limited power and implementation difficulties, such as infrequent ROM, unknown levels of viewing and sharing of feedback, and clinicians’ poor adherence to feedback conditions. Conclusions The study contributes to our limited knowledge about feedback from ROM and underscores the complexity of research on and implementation of ROM within youth mental health care. Trial registration Dutch Trial Register NTR4234 .

scholarly journals The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study

2002 ◽  
Vol 11 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Stefan Priebe ◽  
Rosemarie McCabe ◽  
Jens Bullenkamp ◽  
Lars Hansson ◽  
Wulf Rössler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Psychotic Disorders ◽  
Outcome Measurement ◽  
Treatment Decisions ◽  
Community Mental Health Care

SUMMARYThree issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively ?" easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention – as compared to current best standard practice – will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimised.

Listening to patients' needs to improve their subjective quality of life

2005 ◽  
Vol 35 (11) ◽  
pp. 1655-1665 ◽  
Author(s):  
ANTONIO LASALVIA ◽  
CHIARA BONETTO ◽  
FRANCESCA MALCHIODI ◽  
GIOVANNI SALVI ◽  
ALBERTO PARABIAGHI ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Subjective Quality ◽  
Subjective Quality Of Life ◽  
Community Based ◽  
Prospective Longitudinal

Background. Subjective quality of life has gained a crucial role as a global measure of outcome in mental health care. This study aimed to investigate the impact of meeting needs for care, as assessed by both patients and mental health professionals, to improve the subjective quality of life in a sample of patients receiving community-based psychiatric care.Method. The study was conducted using a 4-year prospective longitudinal design. A cohort of patients from the South-Verona Community-based Mental Health Service (CMHS) was assessed at baseline and follow-up using, among other social and clinical measures, the Camberwell Assessment of Need (both staff and patient versions) and the Lancashire Quality of Life Profile. Predictors of changes of subjective quality of life were explored using block-stratified multiple regression procedures.Results. Improvement in patients' clinical conditions as well as the reduction in patient-rated unmet needs in the social domain predicted an increase in subjective quality of life over 4 years; changes in staff-rated needs did not show any association with changes in subjective quality of life.Conclusions. Meeting self-perceived social needs, beyond symptoms reduction, seems to be of particular importance for ensuring a better quality of life for people with mental disorders. If the main goal of mental health care is to improve the quality of life of users, a policy of actively addressing patient-rated needs should be implemented.

Mental Health and Wellbeing in Japan

2020 ◽  
pp. 233-248
Author(s):  
Norito Kawakami ◽  
Akihito Shimazu
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Common Mental Disorder ◽  
School Mental Health ◽  
Current Status ◽  
Mental Hospitals ◽  
Care And Support

This chapter provides an overview of the history and current status of mental health and mental health care in Japan in the last 50 years. One in 37 people currently receives treatment for any mental disorder, while one in 20 people have experienced a common mental disorder in the past year. Prevalence of mental disorders may not have increased significantly during the last 10–15 years, despite the economic slowdown and social change in this period. Mental hospitals played a central role in treating people with mental disorders, isolated from the community, and the number of beds in mental hospitals per population remains greater in Japan than in other countries. Policy has shifted from inpatient treatment towards community-based care and support, however change is slow. Suicide rates have been influenced by economic factors. The male rate was high between 2000 and 2012. Rates in both sexes have recently declined, but remain above those in other countries. The Japanese have a characteristic perception of wellbeing in the family- and community-oriented collective culture, based on a sense of the meaning of life (ikigai). However, it remains unclear whether the collective culture is entirely beneficial to mental health. In the last decade, Japan has faced several behavioural problems among younger generations, at home and at school. Mental health care in Japan faces many challenges.

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