scholarly journals The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations

Psych ◽  
2021 ◽  
Vol 3 (4) ◽  
pp. 792-799
Author(s):  
Vaios Peritogiannis ◽  
Fotini Tsoli
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Professionals ◽  
Assertive Community Treatment ◽  
Rural Areas ◽  
Community Treatment ◽  
Community Mental Health Service ◽  
Perspective View

The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.

Quality of mental health services: a self audit in the South Verona mental health service

2006 ◽  
Vol 15 (2) ◽  
pp. 138-147 ◽  
Author(s):  
Liliana Allevi ◽  
Giovanni Salvi ◽  
Mirella Ruggeri
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Service ◽  
Health Services ◽  
Community Mental Health Services ◽  
Community Mental Health Service ◽  
Continuous Quality ◽  
One Year

SUMMARYAims – To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise. Methods – The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process. Results – There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service. Conclusions – A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

Compulsory community mental health care: Oceania

2016 ◽  
Author(s):  
Anthony J. O’Brien
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Developing Countries ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Care ◽  
Developed Countries ◽  
Community Treatment ◽  
Community Mental Health Care

Oceania is characterized by the diversity of countries and by highly variable provision of mental health services and community mental health care. Countries such as Australian and New Zealand have well-developed mental health services with a high level of provision, but many less developed countries lack mental health infrastructure. Some developing countries such as Samoa and Tonga have passed mental health legislation with provision for community treatment orders, but this legal measure is probably not a useful mechanism for advancing mental health care in developing countries. Instead, efforts to improve provision of care seem best directed to the primary care sector, and to the general health workforce, rather than to specialists. The UN CRPD offer extensions of human rights to people with mental illness and most countries in Oceania have signed it. However, the absence of a regional rights tribunal potentially limits the realization of those rights.

Mental Health Professionals' Attire

1998 ◽  
Vol 32 (6) ◽  
pp. 880-883 ◽  
Author(s):  
Mani Rajagopalan ◽  
Mario Santilli ◽  
David Powell ◽  
Megan Murphy ◽  
Marice O'brien ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Rural Areas ◽  
Case Manager ◽  
Case Managers ◽  
Small Sample ◽  
Community Mental Health Service ◽  
Mental Health Team ◽  
Mental Health Patients

Objective: Our aim was to obtain mental health patients' views on psychiatrists' and case managers' attire Methods: Eighty-six patients treated at a community mental health service were surveyed. Various types of commonly worn attire were listed. Respondents were asked to choose what they thought was most appropriate for their psychiatrist and case manager to wear. Results: Over 50% of respondents felt that psychiatrist or case manager dress was not an important issue. However, those who felt that it was preferred less formal attire. Conclusions: Psychiatrists and case managers in a community mental health team could consider adopting less formal attire. This conclusion is limited by the small sample and may be relevant to rural areas only. Further research is needed in urban centres. Implications of these findings are discussed.

For a more rational funding system of Mental Health Services. Analyses of costs for services supplied by a Community Mental Health Service during a 7-year period

2001 ◽  
Vol 10 (3) ◽  
pp. 163-179 ◽  
Author(s):  
Paola De Agostini ◽  
Paola Bonizzato ◽  
Francesco Amaddeo ◽  
Giulia Bisoffi ◽  
Federico Perali ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Service ◽  
Health Services ◽  
Community Mental Health Service ◽  
Funding System ◽  
Sono Stati

RIASSUNTOScopo – Negli ultimi anni si è assistito, in Italia come in altri paesi del mondo occidentale, ad un forte aumento dell'interesse, da parte dei ricercatori, per l'economia sanitaria. Anche l'assistenza psichiatrica è stata analizzata riguardo a questi aspetti e, più recentemente, l'attenzione di molti gruppi di lavoro si è rivolta a studi in grado di individuare possibili sistemi di finanziamento dei Servizi psichiatrici altemativi a quelli esistenti e di valutarne l'effetto sul funzionamento dei Servizi. Lo scopo di questo lavoro è quello di definire un nuovo tariffario basato sui costi reali delle prestazioni erogate dai Servizi psichiatrici. Metodo – Utilizzando il Registro Psichiatrico dei Casi di Verona-Sud, sono stati considerati tutti i contatti avvenuti nelle varie sedi del Servizio Psichiatrico Territoriale (SPT) di Verona-Sud in un periodo di 7 anni (1992-1998), per un totale di 125632 prestazioni, riferite a 2819 soggetti. I contatti sono stati successivamente raggruppati in 19 tipi di prestazioni. La funzione di costo è stata utilizzata per descrivere, attraverso la stima dell'elasticit?à, il comportamento dei costi nel SPT di Verona-Sud. Il costo di una prestazione psichiatrica risulta così comprensivo della spesa per gli operatori coinvolti nell'erogazione del servizio (direttamente e/o indirettamente a contatto con il paziente) e del costo delle strutture utilizzate. Risultati – Per ciascuna prestazione vengono riportati (a) i costi stimati per la prestazione effettivamente erogata, (b) il costo stimato al minuto, (c) il costo della prestazione standard erogata con caratteristiche definite (per la durata si è utilizzato il tempo modale rilevato nel campione; per gli operatori, la composizione è stata decisa tenendo conto, da una parte, della reale operatività del SPT e, dall'altra, di considerazioni su quella che potrebbe essere, date le risorse disponibili nel nostro SPT, una buona pratica clinica) ed, infine, (d) i costi relativi alle prestazioni effettuate, raggruppate nelle otto voci contemplate dal Tariffario della Regione Veneto attualmente in vigore. Conclusioni – I risultati hanno dimostrato che le definizioni delle prestazioni, da noi utilizzate, descrivono in maniera soddisfacentemente univoca i diversi tipi di attività svolti dal SPT. Il nomenclatore nazionale attualmente in vigore, invece, avrebbe permesso di descrivere solo il 28% delle prestazioni erogate (35230 su 125632). Ciò dimostra la necessità di disporre, in tempi brevi, di un nuovo nomenclatore delle prestazioni psichiatriche, accettato a livello nazionale, che sia adeguato alle modalita reali con le quali si fomisce assistenza per la salute mentale. I valori di costo da noi ottenuti dimostrano chiaramente che il finanziamento di un Servizio psichiatrico, basato sul nomenclatore nazionale attualmente in vigore, sottostima fortemente le risorse effettivamente utilizzate. La funzione di costo delle diverse prestazioni pud fornire la base per esperienze di finanziamento dei servizi fondato sulle "funzioni assistenziali" previste dal decreto 229 del 1999.

Community Mental Health Nursing in Alberta, Canada: An Oral History

2012 ◽  
Vol 20 (1) ◽  
pp. 103-135 ◽  
Author(s):  
Geertje Boschma
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Oral History ◽  
Mental Health Professionals ◽  
Outpatient Services ◽  
Mental Health Nurses ◽  
1960S And 1970S ◽  
Community Mental Health Nurses

Community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. The purpose of this article is, first, to explore how nurses understood and created their new role and identity in the turbulent context of deinstitutionalization. The development of after care services for patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in Calgary, in the Canadian province of Alberta, will be used as a case study. I specifically focus on the establishment of outpatient services in a new psychiatric department at Foothills General Hospital in Calgary. Second, I examine how deinstitutionalization itself shaped community mental health nurses’ work. Oral history interviews with nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change. The article concludes that new rehabilitative, community-based mental health services can better be understood as a transformation of former institutional practices rather than as a definite break with them.

scholarly journals Changes in community mental health services availability and suicide mortality in the US: A retrospective study

2020 ◽  
Author(s):  
Peiyin Hung ◽  
Susan Busch ◽  
Yi-Wen Shih ◽  
Alecia McGregor ◽  
Shi-Yi Wang
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
The United States ◽  
Suicide Mortality ◽  
Per Capita

Abstract Background: Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States. Methods: Retrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014-2017). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state. Results: From 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3,406 to 2,920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (-0.52, 95% CI -1.08 to 0.03; p=0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths. Conclusions: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts. Keywords: Suicide, Deinstitutionalization, Access to mental health care, Community mental health

Client satisfaction among outpatients attending an Irish community mental health service

2009 ◽  
Vol 26 (3) ◽  
pp. 127-130 ◽  
Author(s):  
Shane Hill ◽  
Niall Turner ◽  
Siobhan Barry ◽  
Eadbhard O'Callaghan
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Service ◽  
Health Services ◽  
Client Satisfaction ◽  
Outcome Variable ◽  
Service Development ◽  
Community Mental Health Service

AbstractObjectives: To assess patient satisfaction with mental health services. Client satisfaction with mental health services is attracting increasing attention and is now considered a key outcome variable in evaluating mental health services. The Quality Framework (Mental Health Commission (MHC)), and Vision for Change (VFC) support such evaluation. However, there are no published quantitative data from Irish users of a community mental health service.Method: We invited outpatients attending a Dublin community mental health service to complete a standardised self-report instrument (Client Satisfaction Questionnaire, CSQ-8) and provide qualitative feedback.Results: Of the seventy-nine respondents, 80% report they were ‘satisfied’ or ‘very satisfied’ with the service. However, they were critical of; access to, operation of, and communication with the mental health services.Conclusions: Although satisfied, when given the opportunity to comment, service users can be critical of aspects of the service they receive. Only using quantitative evaluation of outpatient client satisfaction levels may fail to capture important consumer suggestions for service development. Recent recommendations and upcoming changes would address a number of the criticisms of mental health services identified in this study.

Effectiveness of a 10-week group program based on Dialectical Behaviour Therapy skills among patients with personality and mood disorders: findings from a pilot study

2017 ◽  
Vol 25 (5) ◽  
pp. 466-470 ◽  
Author(s):  
Agatha M Conrad ◽  
Anoop Sankaranarayanan ◽  
Terry J Lewin ◽  
Anna Dunbar
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Service ◽  
Health Services ◽  
Community Mental Health Service ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
The Impact

Objectives: Community mental health services are often required to manage people experiencing repeated crises. Personality disorders are not uncommon, accounting for up to one-third of such presentations. These patients are often difficult to treat, leading to a revolving-door phenomenon. This study evaluated the effectiveness of a pilot intervention in reducing psychological symptoms and distress, and examined the impact of the intervention on mental health service utilization. Methods: A pre- versus post-treatment evaluation was conducted of the effectiveness of a 10-week group psychological intervention based on Dialectical Behaviour Therapy skills, conducted in a regional Australian community mental health service with patients diagnosed with either Cluster B personality disorder or a mood disorder. Results: Of those who completed the program ( N = 38 patients), 84% were female, with an average age of 35.13 years. Participants were active clients of the service for an average of 58.3 weeks prior to the program. They demonstrated significant improvements in quality of life and self-control, and a reduction in hopelessness, cognitive instability and dependence on mental health services. Conclusions: Limiting the Dialectical Behaviour Therapy program to a short-term skills-based group component was successful with the targeted patient group; however, more research is required to establish the generalizability of these results.

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