scholarly journals Improving the delivery and organisation of mental health services: Beyond the conventional randomised controlled trial

2002 ◽  
Vol 180 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Simon Gilbody ◽  
Paula Whitty
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Controlled Trial ◽  
Mental Health Policy ◽  
Randomised Trial ◽  
Experimental Designs ◽  
Random Allocation ◽  
Services Research ◽  
Quasi Experimental

BackgroundThere is an ethical imperative to evaluate service and policy initiatives, such as those highlighted in the recent National Service Framework, just as there is to evaluate individual treatments.AimsTo outline the best methods available for evaluating the delivery and organisation of mental health services.MethodWe present a narrative methodological overview, using salient examples from mental health services research.ResultsCluster randomised studies involve the random allocation of groups of clinicians, clinical teams or hospitals rather than individual patients, and produce the least biased evaluation of mental health policy, organisation or service delivery. Where randomisation is impossible or impractical (often when services or policies are already implemented), then quasi-experimental designs can be used. Such designs have both strengths and many potential flaws.ConclusionsThe gold standard remains the randomised trial, but with due consideration to the unit of randomisation. Use of quasi-experimental designs can be justified in certain circumstances but should be attempted and interpreted with caution.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Novel research on transition from child to adult mental health services in Europe: The MILESTONE project

2016 ◽  
Vol 33 (S1) ◽  
pp. S58-S59 ◽  
Author(s):  
H. Tuomainen ◽  
S.P. Singh ◽  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Service Providers ◽  
Care Pathway ◽  
Controlled Trial ◽  
Ethical Challenges ◽  
Adult Mental Health ◽  
Related Service ◽  
Competing Interest

IntroductionCurrent service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.ObjectivesThe overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.AimsTo improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.MethodsData will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.ResultsFirst results are expected in 2016 with further major findings following in 2019.ConclusionsThe MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental health data: A case for the African communities in New South Wales

2021 ◽  
Vol 42 (1) ◽  
pp. 64-80
Author(s):  
Daniel Kwai Apat ◽  
Wellington Digwa
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
New South ◽  
Mental Health Policy ◽  
New South Wales ◽  
Community Members ◽  
South Wales ◽  
Health Related

This paper examines mental health policies in relation to African communities residing in New South Wales, Australia and the attitudes of African communities toward mental disorders and mental health services. Current mental health policy frameworks have shown an inadequate inclusion of African communities. This may negatively affect the design of mental health interventions and how African communities engage with mental health services. The available mental health literature on African communities showed disjointed and uncoordinated data which focuses on specific community-groups within African communities. Insufficient mental health or suicide data, combined with African community members’ perception toward mental disorders and mental health services, makes it very difficult to progress engagement and interventions. There is a need for proper and sizable data on mental health related to people of African descent in NSW and Australia wide, if positive outcomes are to be realised.

scholarly journals Study protocol for a controlled trial of Strengths Model Case Management in mental health services in Hong Kong

BMJ Open ◽  
2015 ◽  
Vol 5 (10) ◽  
pp. e008303 ◽  
Author(s):  
Wing-See Emily Tsoi ◽  
Samson Tse ◽  
Sadaaki Fukui ◽  
Steven Jones
Keyword(s):  
Mental Health ◽  
Hong Kong ◽  
Mental Health Services ◽  
Health Services ◽  
Case Management ◽  
Study Protocol ◽  
Controlled Trial ◽  
Model Case
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