The role of regional planning and management strategies in the transformation of the healthcare system

2003 ◽  
Vol 16 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Marie-Josée Fleury ◽  
Jean-Louis Denis ◽  
Claude Sicotte
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Regional Planning ◽  
Local Level ◽  
Management Strategies ◽  
Health Sector ◽  
Mental Healthcare ◽  
Public Healthcare ◽  
Planning And Management

Drawing on a case study, this article questions the role of planning and management strategies in the process of transforming a regional public healthcare system that involves a number of organizations and is characterized by fluidity in its functions and division of power. It examines the efficacy of the Regional Plan for the Organization of Health Services (PROS) in reforming the mental health sector in a health and social service district in Quebec, in terms of integrated regional management of mental healthcare and activities at the local level. The regional planning procedure involves a major transformation in management of the mental health system, organizational roles and clinical and professional practices. Our assessment of PROS highlights the importance of taking into account the context of implementation and the instrumental value of planning, before judging its efficacy. To transform a complex healthcare system at the regional and local level, the study suggests a revised conception of the main roles played by planning and of the process shaping its implementation. Our study concludes in favour of developing management strategies at the operational, clinical and professional levels, and integrating them as a planning aid that allows a more corporate and matrix-based system to be set up.

Criminogenic risk and mental health: a complicated relationship

CNS Spectrums ◽  
2019 ◽  
Vol 25 (2) ◽  
pp. 237-244 ◽  
Author(s):  
Robert D. Morgan ◽  
Faith Scanlon ◽  
Stephanie A. Van Horn
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Criminal Justice ◽  
Criminal Behavior ◽  
Psychiatric Rehabilitation ◽  
Management Strategies ◽  
Treatment Needs ◽  
Policy Makers ◽  
Ultimate Concern

The relationship between criminogenic risk and mental illness in justice involved persons with mental illness is complex and poorly understood by clinicians, researchers, administrators, and policy makers alike. Historically, when providing services to justice involved persons with mental illness, clinicians have emphasized mental health recovery (eg, psychiatric rehabilitation) at the exclusion of treatments targeted at criminogenic risk. More recently, however, researchers have demonstrated with great clarity that criminogenic risk not only contributes but is likely the leading factor in the criminal behavior committed by persons with mental illness. Yet, we still do not know the nature of this criminogenic-mental illness relationship, how this relationship impacts treatment needs, and of ultimate concern, what this relationship means in terms of individual and societal outcomes. In this paper we briefly define criminogenic risk and the research that demonstrates the role of criminogenic risk in criminal justice involvement of persons with mental illness. We also review prevalence rates of persons with mental illness justice involvement, and then discuss important factors to be considered when assessing risk to include both criminogenic and mental illness risk. We conclude this paper by reviewing treatment and management strategies for persons with mental illness that are criminal justice involved particularly reviewing and building off the recommendations put forth by Bartholomew & Morgan.

scholarly journals Women's Mental Health in the Time of Covid-19 Pandemic

2020 ◽  
Vol 1 ◽  
Author(s):  
Florence Thibaut ◽  
Patricia J. M. van Wijngaarden-Cremers
Keyword(s):  
Mental Health ◽  
Violence Against Women ◽  
Health Sector ◽  
Health Issues ◽  
Frontline Workers ◽  
Mental Health Issues ◽  
Increased Risk ◽  
The Subject ◽  
At Home

Even if the fatality rate has been twice higher for men than for women, the Covid-19 pandemic has affected women more than men, both as frontline workers and at home. The aim of our article was to analyze the differences observed in mental health and violence between men and women in the COVID outbreak. For this purpose, we have used all papers available in PubMed between January and July 2020 as well as data from non-governmental associations. We have thus successively analyzed the situation of pregnancy during the pandemic; the specific psychological and psychiatric risks faced by women both as patients and as workers in the health sector, the increased risk of violence against women at home and at workplace and, finally the risk run by children within their families. In conclusion, research on the subject of mental health issues during the Covid-19 pandemic is still scarce, especially in women. We hope that this pandemic will help to recognize the major role of women at home and at the workplace.

scholarly journals Access, accountability, and the proliferation of psychological therapy: On the introduction of the IAPT initiative and the transformation of mental healthcare

2019 ◽  
Vol 49 (4) ◽  
pp. 627-650 ◽  
Author(s):  
Martyn Pickersgill
Keyword(s):  
Mental Health ◽  
Controlled Trial ◽  
Mental Healthcare ◽  
Public Mental Health ◽  
Psychological Therapy ◽  
Behaviour Therapy ◽  
Psychological Therapies ◽  
Treatment Of Depression ◽  
Cognitive Behaviour

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health – and the problematization itself – was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term ‘contextification’). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems.

scholarly journals Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

2018 ◽  
Vol 19 (6) ◽  
pp. 902-906 ◽  
Author(s):  
Aimee Moulin ◽  
Ethan Evans ◽  
Guido Xing ◽  
Joy Melnikow
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Health Planning ◽  
Private Insurance ◽  
Mental Healthcare ◽  
Emergency Department Utilization ◽  
Public Healthcare ◽  
Frequent Users ◽  
Ed Visits

Introduction: Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs. Methods: This retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder. Results: In the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92-4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27-1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20-3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94-3.25]) were also more likely to be frequent users compared with those with private insurance coverage. Conclusion: Patients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.

scholarly journals Mental healthcare in Brazil: modest advances and major challenges

2014 ◽  
Vol 20 (2) ◽  
pp. 113-115 ◽  
Author(s):  
Jair de Jesus Mari
Keyword(s):  
Mental Health ◽  
Healthcare System ◽  
Psychiatric Care ◽  
Mental Healthcare ◽  
Health Indicators ◽  
The Future

SummaryThis brief article describes the main health indicators of Brazil and gives an overview of psychiatric care. It points out the primary pitfalls of the mental healthcare system and presents some suggestions for the future of mental health in the country.

scholarly journals Governance of the public health sector during Apartheid: The case of South Africa

2016 ◽  
Vol 5 (1) ◽  
pp. 23-30
Author(s):  
Melody Brauns ◽  
Anne Stanton
Keyword(s):  
South Africa ◽  
Healthcare System ◽  
Health Sector ◽  
African National Congress ◽  
Public Healthcare ◽  
The Public ◽  
South Africans ◽  
Official Policy ◽  
National Congress ◽  
Set Up

The healthcare system that the African National Congress (ANC) government inherited in 1994 can hardly be described as functional. Indeed the new government had inherited a combination of deliberate official policy, discriminatory legislation and at times blatant neglect. This paper presents an overview of the evolution of the healthcare system in South Africa. The structures set up under apartheid had implications for provision of public healthcare to South Africans and reveals how governance structures, systems and processes set up during apartheid had implications for the provision of public healthcare to South Africans.

Panchayati Raj and Rural Health Care Delivery System in Karnataka

2020 ◽  
Vol 66 (1) ◽  
pp. 97-109
Author(s):  
D. C. Nanjunda
Keyword(s):  
Rural Health ◽  
Healthcare System ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Public Healthcare ◽  
The Public ◽  
Quality Health ◽  
Grassroots Level ◽  
Panchayati Raj

It is commonly opined that decentralisation through Panchayati Raj Institutions (PRIs) can help in creating greater accountability in the Indian healthcare system. Health decentralisation is specially meant for peoples’ participation, increased transparency and a higher degree of accountability to provide comprehensive and quality health services at the grassroots level. The National Rural Health Mission (NRHM) visualises the provision of decentralised healthcare at the grassroots level. However, this scheme has some lacunas in reaching the needy, especially in the rural parts of India because of an ineffective and non-participatory role of PRIs in decision making. This has been ascribed to a malfunction in creating healthcare awareness and making the procedures complicated and chaotic for the local Panchayats. The article is based on the Indian Council of Medical Research-funded study in the state of Karnataka. It seeks to find out how PRIs are managing the public healthcare system and its success and failure through a qualitative study. The study has shown that some amount of caution is needed in devolving requisite powers to the PRIs within the NRHM. The coordination between Public Health Institute officials and those of PRIs is completely absent and most of the PRI members do not even know about various health schemes.

scholarly journals Squaring the circle: developing clinical risk management strategies in mental healthcare organisations

2013 ◽  
Vol 19 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Billy Boland ◽  
Sandy Bremner
Keyword(s):  
Risk Management ◽  
Management Practice ◽  
Local Level ◽  
Management Strategies ◽  
Mental Healthcare ◽  
Evidence Base ◽  
Current Evidence ◽  
Clinical Risk Management ◽  
Clinical Risk ◽  
Current Evidence Base

SummaryThis article explores the challenges of developing clinical risk management practice and policy within large mental healthcare organisations. The national context is outlined and requirements of organisations explained. Consideration is given to how clinical risk relates to clinical quality and the benefits of standardisation are explored. We highlight the complexities and conflicts of implementing standardised procedures, given the current evidence base, and the difficulties of applying this in clinical practice. Using concepts from strategic planning and psychology, we suggest an approach to respond to these factors at a local level to achieve better outcomes for service users and clinicians.

More than Pills and Beds

2014 ◽  
pp. 113-129
Author(s):  
Sebastian Rosenberg ◽  
Fiona McDermott
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Social Workers ◽  
Mental Healthcare ◽  
Theory And Practice ◽  
Mental Health Recovery ◽  
Social Work Theory ◽  
Integral Element ◽  
The Way

Contemporary models of mental healthcare emphasise the importance of multi-disciplinary approaches in supporting recovery for consumers. There is growing evidence of the key role to be played by social workers derived from both the principles of recovery and those underpinning social work theory and practice, particularly a focus on person-in-environment. However, pressures on the way mental healthcare is provided in Australia are threatening this confluence. These pressures are much more concerned with the needs of funders than professionals, consumers, and their families. The aim of this chapter is to explore the evidence to support social work as an integral element in mental health recovery and to better understand these emerging challenges. The role of social work in good mental healthcare is too important to become marginalized; yet this prospect is real. Better understanding of the contemporary landscape of social work can help ensure this does not occur.

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