Importance of specialisation in psychiatric services: Commentary on … How did we let it come to this?

SummaryIn this issue, Dr Lodge makes a plea for continuity of care in the face of the increased specialisation of mental healthcare over recent years. However, continuity of care is not a straightforward concept and its relationship to clinical outcome is not established. The increased specialisation of mental healthcare reflects an evolving evidence base that has increased our understanding of mental illness and the treatments and delivery systems that are most effective. In other words, specialisation is the sign of a progressive field.

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Economic Perspectives on Setting up and Running Telepsychiatry Services in India

Indian Journal of Psychological Medicine ◽

10.1177/0253717620966205 ◽

2020 ◽

Vol 42 (5_suppl) ◽

pp. 10S-16S

Author(s):

Khushboo Dewani ◽

Chethan Basavarajappa ◽

Guru S Gowda ◽

Mahesh Gowda ◽

Preeti Srinivasa ◽

...

Keyword(s):

Mental Illness ◽

Real Estate ◽

Human Resources ◽

Mental Healthcare ◽

Psychiatric Services ◽

Potential Game ◽

Viable Option ◽

Practice Of Medicine ◽

Economic Perspectives ◽

Legal Grounds

Background: Telemedicine Practice Guidelines, 2020 and Telepsychiatry Operational Guidelines, 2020 can be potential game changers in the practice of medicine in India. They provide legal grounds for the practice of telemedicine. The economics of setting up and running telepsychiatry services vis-à-vis in-person services in India is discussed in this paper to aid the practitioners in understanding the costs involved in each of these modalities. Methods: Costs for various hardware, software, real estate, and human resources are collated from various sources. Telepsychiatry vs. in-person setup is compared for the costs involved. Results: Telepsychiatry consultation will cost much lesser to that of in-person consultation. Conclusions: Telepsychiatry is an economically viable option. There are many benefits and hurdles in telepsychiatry practice. It is a step towards providing psychiatric services at the doorstep in compliance with the Mental Healthcare Act 2017, upholding the rights of persons with mental illness. It will benefit the practitioner, the patient, and the society.

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Rates of mental disorder in people convicted of homicide

The British Journal of Psychiatry ◽

10.1192/bjp.188.2.143 ◽

2006 ◽

Vol 188 (2) ◽

pp. 143-147 ◽

Cited By ~ 73

Author(s):

Jenny Shaw ◽

Isabelle M. Hunt ◽

Sandra Flynn ◽

Janet Meehan ◽

Jo Robinson ◽

...

Keyword(s):

Mental Illness ◽

Mental Disorder ◽

Severe Mental Illness ◽

Mental Healthcare ◽

Psychiatric Services ◽

England And Wales ◽

History Of ◽

Clinical Survey ◽

The Relationship ◽

Diminished Responsibility

BackgroundPrevious studies of people convicted of homicide have used different definitions of mental disorder.AimsTo estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court.MethodA national clinical survey of people convicted of homicide (n=1594) in England and Wales (1996–1999). Rates of mental disorder were estimated based on: lifetime diagnosis, mental illness at the time of the offence, contact with psychiatric services, diminished responsibility verdict and hospital disposal.ResultsOf the 1594, 545 (34%) had a mental disorder: most had not attended psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had symptoms of mental illness at the time of the offence; 149 (9%) received a diminished responsibility verdict and 111 (7%) a hospital disposal – both were associated with severe mental illness and symptoms of psychosis.ConclusionsThe findings suggest an association between schizophrenia and conviction for homicide. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Some perpetrators receive prison sentences despite having severe mental illness.

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The trouble with NHS psychiatry in England

Psychiatric Bulletin ◽

10.1192/pb.bp.108.023184 ◽

2009 ◽

Vol 33 (6) ◽

pp. 219-225 ◽

Cited By ~ 7

Author(s):

Paul St John-Smith ◽

Daniel McQueen ◽

Albert Michael ◽

George Ikkos ◽

Chess Denman ◽

...

Keyword(s):

Mental Illness ◽

Psychosocial Support ◽

Psychosocial Care ◽

Mental Healthcare ◽

Psychiatric Services ◽

Diagnostic Assessment ◽

Central Importance ◽

New Ways Of Working ◽

People With Mental Illness ◽

Specific Disorders

SummaryIn ‘Wake-up call for British psychiatry’ Craddock et al explained how recent attempts to improve psychosocial care for people with mental illness focus on non-specific psychosocial support. This has been at the expense of proper diagnostic assessment and prescription of treatment by psychiatrists aimed at treatment of specific disorders and recovery. They describe a creeping devaluation of psychiatry which is caricatured as narrow, biological, reductionist, oppressive, discriminatory and stigmatising. Some trusts have implemented ‘New Ways of Working for Psychiatrists’ in a way that undermines the central importance of psychiatrists in mental healthcare. Consequently, patients may be treated in secondary care without ever being seen by a psychiatrist. We consider a number of different changes that have interacted in unforeseen ways, with unintended adverse consequences for psychiatric services in England. We aim to continue the debate here.

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Lived Experiences of Young People who Live with Mental Healthcare Users in Limpopo, South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4713 ◽

2020 ◽

Vol 22 (2) ◽

Author(s):

Mamakota Maggie Molepo ◽

Faniswa Honest Mfidi

Keyword(s):

South Africa ◽

Mental Illness ◽

Young People ◽

Lived Experiences ◽

Daily Living ◽

Support Systems ◽

Family Members ◽

Mental Healthcare ◽

Limpopo Province ◽

Burden Sharing

Mental illness is more than just the diagnosis to an individual – it also has an impact on the social functioning of the family at large. When a parent or relative has a mental illness, all other family members are affected, even the children. The purpose of the study was to provide insight into the lived experiences of young people who live with mental healthcare users and the way in which their daily coping can be maximised. A qualitative, descriptive, phenomenological research was undertaken to explore and describe the lived experiences of young people who live with mental healthcare users in the Limpopo province, South Africa. Audiotaped, unstructured in-depth interviews were conducted with 10 young people who grew up and lived with a family member who is a mental healthcare user in their homes, until data saturation was reached. A content analysis was used to derive themes from the collected qualitative data. Four major themes emerged as features reflective of the young people’s daily living with mental healthcare user, namely psychological effects, added responsibilities, effects on school performances, and support systems. This study recommends that support networks for young people be established through multidisciplinary team involvement and collaboration and the provision of burden-sharing or a relief system during times of need. With the availability of healthy coping mechanisms and support systems, the daily living situations and coping of young people could be maximised, thereby improving their quality of life while living with their family members with mental illness.

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Overcoming the Complexities of Mental Illness and Homelessness

MacEwan University Student eJournal ◽

10.31542/j.muse.98 ◽

2014 ◽

Vol 1 (1) ◽

Author(s):

Chelsea Lee Dost

Keyword(s):

Mental Illness ◽

Social Work ◽

General Population ◽

Continuity Of Care ◽

Contributing Factors ◽

The Many

Mental illness and homelessness are inextricably tied together in a way that has created a costly problem which profoundly affects both individuals and society. To begin to eradicate this problem, the severity and complexity must be understood by considering the many contributing factors to both mental illness and homelessness. Care must be individualized to fit each person’s unique situation, and continuity of care is absolutely critical. This problem has ramifications for many disciplines such as healthcare, social work, corrections, and housing, but stigma in the general population must also be addressed if progress is to be made.

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Electronic Communication, Telehealth, and Social Media

10.1093/oxfordhb/9780190634841.013.46 ◽

2018 ◽

Author(s):

Muniya S. Khanna ◽

Tommy Chou

Keyword(s):

Social Media ◽

Rural Communities ◽

Unmet Need ◽

Mental Healthcare ◽

Evidence Base ◽

Intervention Delivery ◽

Safety Issues ◽

Video Teleconferencing ◽

Empirically Supported ◽

Traditional Service

Explosive growth of communication technologies and increased ubiquity of Internet access in both urban and rural communities and particularly in youth have occurred. Coupled with concerns regarding limitations to traditional service provision models, researchers and practitioners are looking to affordable, acceptable technologies to expand the reach of evidence-based care and reduce barriers to intervention and unmet need in areas with few providers. This chapter describes the present literature on use of video teleconferencing, web-based programs, social media, and smartphone apps to enhance mental health intervention delivery, psychiatric assessment, and training and supervision. The strengths of the various delivery methods are discussed for providing empirically supported mental healthcare, focusing on implications related to science and practice with children and families. Outlined also are current limitations, risks, and challenges to technology-mediated services, including the significant gaps in the evidence base underlying these technologies and the legal, ethical, and safety issues that remain.

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Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports

Homeopathy ◽

10.1055/s-0040-1701251 ◽

2020 ◽

Vol 109 (04) ◽

pp. 191-197

Author(s):

Chetna Deep Lamba ◽

Vishwa Kumar Gupta ◽

Robbert van Haselen ◽

Lex Rutten ◽

Nidhi Mahajan ◽

...

Keyword(s):

Clinical Outcome ◽

Causal Relationship ◽

Clinical Case ◽

Assessment Tool ◽

Causal Attribution ◽

Case Reports ◽

Face Validity ◽

Rater Agreement ◽

The Face ◽

Selection Of

Abstract Objectives The objective of this study was to establish the reliability and content validity of the “Modified Naranjo Criteria for Homeopathy—Causal Attribution Inventory” as a tool for attributing a causal relationship between the homeopathic intervention and outcome in clinical case reports. Methods Purposive sampling was adopted for the selection of information-rich case reports using pre-defined criteria. Eligible case reports had to fulfil a minimum of nine items of the CARE Clinical Case Reporting Guideline checklist and a minimum of three of the homeopathic HOM-CASE CARE extension items. The Modified Naranjo Criteria for Homeopathy Inventory consists of 10 domains. Inter-rater agreement in the scoring of these domains was determined by calculating the percentage agreement and kappa (κ) values. A κ greater than 0.4, indicating fair agreement between raters, in conjunction with the absence of concerns regarding the face validity, was taken to indicate the validity of a given domain. Each domain was assessed by four raters for the selected case reports. Results Sixty case reports met the inclusion criteria. Inter-rater agreement/concordance per domain was “perfect” for domains 1 (100%, κ = 1.00) and 2 (100%, κ = 1.00); “almost perfect” for domain 8 (97.5%, κ = 0.86); “substantial” for domains 3 (96.7%, κ = 0.80) and 5 (91.1%, κ = 0.70); “moderate” for domains 4 (83.3%, κ = 0.60), 7 (67.8%, κ = 0.46) and 9 (99.2%, κ = 0.50); and “fair” for domain 10 (56.1%, κ = 0.38). For domains 6A (46.7%, κ = 0.03) and 6B (50.3%, κ = 0.18), there was “slight agreement” only. Thus, the validity of the Modified Naranjo Criteria for Homeopathy tool was established for each of its domains, except for the two that pertain to direction of cure (domains 6A and 6B). Conclusion The Modified Naranjo Criteria for Homeopathy—Causal Attribution Inventory was identified as a valid tool for assessing the likelihood of a causal relationship between a homeopathic intervention and clinical outcome. Improved wordings for several criteria have been proposed for the assessment tool, under the new acronym “MONARCH”. Further assessment of two MONARCH domains is required.

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Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

BMC Psychiatry ◽

10.1186/s12888-021-03180-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhong Li ◽

Sayward E. Harrison ◽

Xiaoming Li ◽

Peiyin Hung

Keyword(s):

Continuity Of Care ◽

Psychiatric Care ◽

The United States ◽

Psychiatric Services ◽

Linear Regression Models ◽

Cross Sectional ◽

Promising Alternative ◽

American Hospital ◽

American Hospital Association ◽

Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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