scholarly journals Evidence on the capacity of severe mental disorder patients to make well-founded decisions about their healthcare: a meta-review

2020 ◽  
Author(s):  
Alfredo Calcedo-Barba ◽  
Ana Fructuoso ◽  
José Martinez Raga ◽  
Silvia Paz ◽  
Manuel Sanchez de Carmona ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Mental Disorder ◽  
Community Dwelling ◽  
Current Evidence ◽  
Free Text ◽  
Severe Mental Disorder ◽  
Review Articles ◽  
Meta Review

Abstract Background Determining the mental capacity of psychiatric patients for making decisions regarding treatment acceptance or refusal is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make well-founded medical care decisions. Methods Systematic review of literature review articles following PRISMA recommendations. PubMed, Scopus and CINAHL were electronically searched up to 30 September 2019. Free text searches and medical subject headings in English were combined. Publications were selected as per inclusion and exclusion criteria. The AMSTAR 2 tool was used to assess the quality of reviews. Results Thirteen publications were reviewed. In one review, up to 67% of patients in a mixed psychiatric population had capacity to decide about admissions; 71% (median) had capacity for making decisions about treatments. In another, community-dwelling or clinically stable psychiatric outpatients were close to non-psychiatric subjects in decision capacity performance. In a third review, people with psychosis had moderately impaired risk-reward decision-making ability compared with healthy individuals (g =-0.57, 95% CI: -0.66 to -0.48; I 2 45%), and were more likely to value rewards over losses (k = 6, N = 516, g = 0.38, 95% CI 0.05 to 0.70, I 2 64%) and to base decisions on recent rather than past outcomes (k = 6, N =516, g = 0.30, 95% CI: -0.04 to 0.65, I 2 68%). In a fourth review, future care (crisis) planning led to a 40% reduction in the use of compulsory inpatient treatment over 15 to 18 months. In other reviews, patients with mental illness were able to provide valid preference measures and gave sufficiently consistent answers regarding their preferred treatments. Decision-making responded favourably to interventions. The publications complied satisfactorily with the AMSTAR 2 critical domains. Conclusions Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder are able to make rational decisions about their care. Best practice strategies should help mentally ill patients grow into voluntary and safe users of medications, enabling them to keep a sense of control over their lives and enhancing their health-related quality of life.

scholarly journals Digital health interventions in palliative care: a systematic meta-review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Hannah O’Donnell ◽  
Jean Lugton ◽  
Tilly Gibson-Watt ◽  
Connie Swenson ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Systematic Reviews ◽  
Psychological Symptoms ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Information Provision ◽  
Health Interventions ◽  
Meta Review

AbstractDigital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

scholarly journals EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
W. Gaebel ◽  
A. Kerst ◽  
B. Janssen ◽  
T. Becker ◽  
M. Musalek ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Care Coordination ◽  
Mental Healthcare ◽  
Advantages And Disadvantages ◽  
Meta Review ◽  
Effectiveness And Efficiency

Abstract Background. The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services. Methods. We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases. Results. We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare. Conclusions. Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.

Best practices in perinatal mental health for mothers with severe mental illness

2017 ◽  
Vol 41 (S1) ◽  
pp. 911-911
Author(s):  
L. Howard
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Best Practices ◽  
Perinatal Period ◽  
Current Evidence ◽  
Pharmacological Treatments ◽  
Profound Impact ◽  
Competing Interest

Perinatal mental disorders are common and can have a profound impact on women and their families. This session will briefly review the epidemiology of disorders in the perinatal period and current evidence on pharmacological and non-pharmacological treatments. The role of the psychiatrist in helping women in their decision-making on treatment will be discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Newspaper Articles Related to the Not Criminally Responsible on Account of Mental Disorder (NCRMD) Designation: A Comparative Analysis

2017 ◽  
Vol 62 (10) ◽  
pp. 697-701 ◽  
Author(s):  
Rob Whitley ◽  
JiaWei Wang ◽  
Victoria Carmichael ◽  
Ruth Wellen
Keyword(s):  
Mental Illness ◽  
Quality Of Care ◽  
Mental Disorder ◽  
Poor Quality ◽  
Major Theme ◽  
Not Criminally Responsible ◽  
The Media ◽  
Negative Tone ◽  
Newspaper Articles

Objective: The not criminally responsible on account of mental disorder (NCRMD) designation remains widely misunderstood by the public. Such misunderstandings may also be reflected in the media. As such, the aim of this study is to conduct a preliminary examination of the tone and content of recent Canadian newspaper articles where NCRMD is a major theme, comparing these to generic articles about mental illness. Methods: Articles about mental illness were gathered from major Canadian newspapers. These were then divided into two categories: 1) articles where NCRMD was a major theme and 2) articles where NCRMD was not a major theme. Articles were then coded for the presence or absence of 1) a negative tone, 2) stigmatising tone/content, 3) recovery/rehabilitation as a theme, and 4) shortage of resources/poor quality of care as a theme. Results: The retrieval strategy resulted in 940 articles. Fourteen percent ( n = 131) of all articles had NCRMD as a major theme. In comparison to generic articles about mental illness, articles with NCRMD as a major theme were significantly more likely to have a negative tone ( P < 0.001) and stigmatising tone/content ( P < 0.001) and significantly less likely to have recovery/rehabilitation ( P < 0.001) or shortage of resources/poor quality of care as a theme ( P < 0.001). Conclusions: Articles with NCRMD as a theme were overwhelmingly negative and almost never focused on recovery or rehabilitation, in stark comparison to generic articles about mental illness.

scholarly journals The quality of severe mental disorder diagnoses in a national health registry as compared to research diagnoses based on structured interview

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Ragnar Nesvåg ◽  
Erik G. Jönsson ◽  
Inger Johanne Bakken ◽  
Gun Peggy Knudsen ◽  
Thomas D. Bjella ◽  
...  
Keyword(s):  
Mental Disorder ◽  
National Health ◽  
Structured Interview ◽  
Severe Mental Disorder ◽  
Health Registry

scholarly journals ‘Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness’

2021 ◽  
pp. 002076402110018
Author(s):  
Gillian Mezey ◽  
Sarah White ◽  
Isobel Harrison ◽  
Jennifer Bousfield ◽  
Helen Killaspy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Personality Disorder ◽  
Mental Disorder ◽  
Social Inclusion ◽  
Common Mental Disorder ◽  
Service Users

Background: Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion. Aims: (1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness. Method: Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations. Results: About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age ( p = .008), lack of higher education ( p < .001), more previous admissions ( p = .005), severity of current symptoms and greater experienced stigma ( p = .006) and anticipated stigma ( p = .035). Greater social inclusion was associated with better quality of life ( p < .001) and less loneliness ( p < .001). Conclusions: Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people’s social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

scholarly journals Community Based Pasung Release on Schizophrenia

2021 ◽  
Vol 10 (1) ◽  
pp. 27
Author(s):  
Titik Dyah Agustini ◽  
Azimatul Karimah ◽  
Ivana Sajogo
Keyword(s):  
At Risk ◽  
Mental Illness ◽  
Mental Disorder ◽  
Assertive Community Treatment ◽  
Community Treatment ◽  
Severe Mental Disorder ◽  
Community Based ◽  
Hospitalization Rates ◽  
People With Mental Illness ◽  
The Government

Schizophrenia is a severe mental disorder, persistent, chronic, easy to relapse. Schizophrenics at risk of becoming victims of pasung. Confinement is any form of limitation of movement of people with mental illness by families and/or communities. The government has launched the program to end pasung, but the incidence of pasung in the community is still quite high. Liberation of community-based pasung includes prevention of pasung, handling of pasung and rehabilitation of post-pasung. The method of community-based pasung release at the rehabilitation stage that is widely used is Assertive Community Treatment (ACT) and has been proven to reduce recurrence and hospitalization rates in schizophrenics so as to reduce the incidence of pasung and prevent re-pasung.

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