scholarly journals Mental Healthcare Delivery in Rural Greece: A 10-year Account of a Mobile Mental Health Unit

2017 ◽  
Vol 08 (04) ◽  
pp. 556-561 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Thiresia Manthopoulou ◽  
Afroditi Gogou ◽  
Venetsanos Mavreas
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
Rural Areas ◽  
Catchment Area ◽  
Mental Healthcare ◽  
Community Mental Health Service ◽  
Primary Care System ◽  
Mobile Mental Health ◽  
Care System

ABSTRACTIntroduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system.

scholarly journals Treatment Engagement of Psychotic Patients with a Mobile Mental Health Unit in Rural Areas in Greece: A Five-Year Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Athina Tatsioni ◽  
Nefeli Menti ◽  
Aikaterini Grammeniati ◽  
Vassiliki Fotopoulou ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Low Income ◽  
Rural Areas ◽  
Psychotic Disorders ◽  
Low Income Countries ◽  
Community Mental Health Service ◽  
Health Unit ◽  
Mobile Mental Health ◽  
Mental Health Unit

Objectives. Treatment of psychotic disorders is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. This study examined the engagement rates of psychotic patients with a community mental health service during a 5-year period.Methods. The Mobile Mental Health Unit of Ioannina and Thesprotia (MMHU I-T) delivers services in remote, rural, mountainous areas using the resources of the primary care system. Clinical and demographic information for patients with a diagnosis of schizophrenia and related psychoses was obtained from the medical records of our unit.Results. A total of 74 psychotic patients initially engaged in treatment with our unit. In half of cases treatment was home-based. With the exclusion of patients who died or discharged, engagement rates were 67.2%. Statistical analysis was performed for 64 patients, and no differences were found between engaged and disengaged patients regarding clinical and demographic parameters. All engaged patients regularly refilled their antipsychotic prescriptions.Conclusion. Engagement rates in our study were comparable to previous research, involving urban settings and shorter follow-up duration. Community mental health teams may ensure treatment continuation for psychotic patients in deprived, remote areas. This is important for low-income countries, affected by economic crisis, such as Greece.

scholarly journals Mental healthcare for older adults in rural Greece

2015 ◽  
Vol 28 (4) ◽  
pp. 698-700
Author(s):  
Vaios Peritogiannis ◽  
Athina Tatsioni ◽  
Thiresia Manthopoulou ◽  
Venetsanos Mavreas
Keyword(s):  
Mental Health ◽  
Rural Areas ◽  
Catchment Area ◽  
Mental Healthcare ◽  
Rural And Remote ◽  
North West ◽  
Remote Areas ◽  
Rural And Remote Areas ◽  
Mobile Mental Health ◽  
Of Greece

Community mental healthcare in rural and remote areas of Greece is mostly delivered by generic Community Mental Health Teams (CMHTs), namely the Mobile Mental Health Units (MMHUs). In Epirus, north-west Greece, one of the poorest regions in Europe, the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) has been established in 2007 and provides services to a population grossly estimated at 100,000 per size of the catchment area in remote and mostly mountainous rural areas. The establishment of the MMHU I-T and its contribution to the care of patients with psychosis has been described elsewhere (Peritogiannis et al., 2011).

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.

Improving physical health of patients with mental health problems

2011 ◽  
Vol 26 (S2) ◽  
pp. 1234-1234
Author(s):  
F. Cheema ◽  
J. Graham ◽  
D. Moffat ◽  
C. Gordon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Health Problems ◽  
Community Mental Health Service ◽  
Individual Parameter ◽  
Mental Health Difficulties

It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.[Physical health monitoring by individual parameter]

scholarly journals Integrating mental health into primary care: the policy maker's perspective and experience in China

2010 ◽  
Vol 7 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Yu Xin ◽  
Liu Jin ◽  
Ma Hong
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Care Service ◽  
Psychiatric Service ◽  
Mental Healthcare ◽  
Health Resources ◽  
Psychiatric Hospitals ◽  
Administration And Supervision ◽  
Set Up

In China, ‘community’ was an alien word. Many people used to live in dormitories (Danwei), to which they were assigned by government according to their work units. ‘Dormitory form’ community was closely linked to where people worked, and thus administration and supervision were simple, as was the provision of health services. In each Danwei, a clinic provided basic healthcare not only for its employees but also for the other residents of the dormitory. The old primary care service was based on this. In fact, the ‘golden age’ of community mental healthcare was at that time, when psychiatric hospitals extended their service to communities via the Danwei's clinics in the cities and via ‘barefoot doctors’ in the rural areas. Home beds, occupational therapy stations and shelter factories were set up in some cities and mobile mental health teams played important roles in the villages. Although this did not really represent the ‘integration’ of mental health into primary care, it was a good example of maximising the utilisation of the very limited mental health resources by stretching the psychiatric service, using administrative power, and mobilising family members (Shen et al, 1990; Zhang & Yan, 1990; Zhang, 1999).

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.

scholarly journals Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Bibhav Acharya ◽  
Jasmine Tenpa ◽  
Poshan Thapa ◽  
Bikash Gauchan ◽  
David Citrin ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Care System ◽  
Rural Nepal ◽  
Care System

Should all community mental health teams be sectorised?

2020 ◽  
Vol 37 (1) ◽  
pp. 48-54
Author(s):  
R. Vaughan ◽  
K. Antczak ◽  
L. Kowalewski ◽  
L. Feeney
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Health Service Delivery ◽  
Community Mental Health Service ◽  
Service Users ◽  
Health Service Provision ◽  
Catchment Areas

ObjectivesSectorised catchment areas have characterised Irish mental health service delivery since the devolution of institutional care. Unlike other catchment areas, the Cluain Mhuire Community Mental Health Service (CMCMHS) never sectorised. With the development of Community Health Networks (CHNs) and Primary Care Centres, the CMCMHS has come under renewed pressure for structural change. We aimed to consider the implications of these proposed changes on staff and service users.MethodWe obtained demographic information comparing the CHNs with respect to attendee numbers, new referrals and admissions over a 1- year period. Secondly, we conducted an anonymous survey seeking opinions on the proposals to switch to a sector-based model and/or specialist inpatient care.ResultsReferral and admission rates differed across CHNs, broadly consistent with populations. About 36% of staff and 33% of service users supported changing to a sector-based system. In the event of a sector-based system of care being implemented, 66% of service users felt that existing service users should remain under the care of their current team. There was little support among any group for the development of specialist inpatient teams.ConclusionsWe discuss the benefits and drawbacks of sectorisation of mental health service provision. Most patients did not want to change teams either as current service users or as re-referrals (indicating it will take a significant time to transition to a sector-based system). Without clear pathways towards integration with primary care teams, the advantages of sectorisation may not outweigh the challenges associated with its implementation.

scholarly journals Primary Care Practitioners’ Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study

2020 ◽  
Vol 35 (11) ◽  
pp. 3278-3284
Author(s):  
Zhijie Xu ◽  
Yuanqu Ye ◽  
Yang Wang ◽  
Yi Qian ◽  
Jianjiang Pan ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Rural Areas ◽  
Community Health Centers ◽  
Comparative Method ◽  
Health Centers ◽  
Primary Care System ◽  
Epidemic Control ◽  
Primary Care Practitioners ◽  
Care System

Abstract Background The coronavirus disease 2019 (COVID-19) emerged in December 2019 and posed numerous challenges to China’s health system. Almost 4 million primary care practitioners (PCPs) participated in controlling the outbreak. However, PCPs’ barriers to and experience of the epidemic control remain unknown and are essential for improving countermeasures. Objective To better understand the barriers PCPs faced in COVID-19 epidemic control and their psychological and occupational impacts, and explore potential solutions. Design This qualitative study was conducted through semi-structured, in-depth interviews from February 12, to March 10, 2020. Participants A purposive sample of frontline PCPs affiliated with either community health centers or township health centers in four provinces of China were recruited. Approach Interviews were conducted by telephone, and then recorded, transcribed, and content analyzed. Themes surrounding PCPs’ barriers to COVID-19 epidemic control, their experience, and potential solutions were iteratively identified using the constant comparative method. Key Results Of the 21 PCPs interviewed, 10 (48%) were women and 5 (24%) worked in rural areas. Barriers to epidemic control in primary care included inappropriate PCP scheduling and role ambiguity, difficult tasks and inadequate capacities, and inexperienced community workers and insufficient cooperation. Some PCPs perceived respect and a sense of accomplishment and were preoccupied with the outbreak, while others were frustrated by fatigue and psychological distress. PCPs reported potential solutions for improving countermeasures, such as improving management, optimizing workflows, providing additional support, facilitating cooperation, and strengthening the primary care system. Conclusions Due to their roles in controlling the COVID-19 epidemic, PCPs in China faced a series of barriers that affected them physically and mentally. Support for PCPs should help them to overcome these barriers and work efficiently. The current findings provide insight into the challenges and potential solutions for strengthening the preparedness and response of China’s primary care system in future disease outbreaks.

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