An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service

Background Family-based treatment (FBT) has demonstrated efficacy for anorexia nervosa (AN) in youth in randomized, controlled trials. It is important to assess if it shows a similar effectiveness when implemented in standard care. Aim To evaluate outcomes of FBT for restrictive-type eating disorders, delivered as standard care in a public mental health service. Outcomes are remission, frequency of hospital admissions and day-patient treatment, and frequency of other adaptations within 12 months from commencement of treatment. Second, to compare the collaborative clinical decisions of successful treatment in standard care made by family therapist at the end of treatment, with more objective definitions of recovery. Methods The design is a prospective, uncontrolled study of a consecutive series of patients with restrictive-type eating disorders, treated with FBT in a specialty unit at the Child and Adolescent Mental Health Centre in the Capital Region of Denmark. Results FBT was successfully completed within 12 months by 57% of participants, and 47% completed with 20 sessions or fewer. Weight restoration was achieved by 75% within 12 months, and 46% achieved both normalisation of body weight and behavioural symptoms of AN within 12 months. A total of 20% needed intensified treatment. All aspects of remission were often not present simultaneously, and the collaborative clinical decisions of successful treatment only partly aligned with other parameters of remission. Conclusion FBT showed good results when implemented as standard care, and it can be adapted to the specifics of local service organisation without compromising effectiveness.

Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

Borderline Personality Disorder Diagnosis and Symptoms in Outpatient Youth as Risk Factors for Criminal Offenses and Interpersonal Violence

The aim of the current study was to examine the risk for offending among outpatient youth with borderline pathology. Demographic and diagnostic data from 492 outpatients who attended a public mental health service for 15- to 25-year-olds between January 1998 and March 2008 were linked with information regarding criminal offenses and intervention orders collected from a statewide police database between March 1993 and June 2017. BPD diagnosis and number of BPD criteria were both associated with an elevated risk for violent and nonviolent offenses and family violence intervention orders. Moderation analyses revealed that the number of BPD criteria might affect males and females differently in terms of offending. Both impulsivity and anger independently predicted the risk for violent and nonviolent offenses and family violence intervention orders. Early detection of increased risk of offending among youth with BPD features is essential to develop targeted treatments for criminal or violent behavior.

The COVID-19 Pandemic and Italian Public Mental Health Services: Experience and Future Directions

The COVID-19 pandemic has crosses every health care area (from primary care to specialist ones), leading to a review of all public health policies. The use of smart working allows important technological innovations, but it must be accompanied by a review of hospital and residential programs and locations. Since many institution are talking about economic investments for mental health (a crucial area for a full recovery of the society), specific funds are needed in mental health professionals (eg, psychologists), skills, and innovation of locations and technology, such as the conversion of psychiatric wards to community services that carefully must consider the patient experience and clinician’s point of view. Some considerations on the COVID-19 experience in Italy are reported, and suggestions on future directions for public mental health service organization are hypothesized.

Towards a Recovery Orientated Mental Health Service

Background: In 2006, in a policy document entitled a Vision for Change(Department of Health, 2006), Ireland undertook to move towards a modern,recovery orientated public mental health service characterised by holisticcare, individualised care planning, the provision of accessible support,increased involvement of service users in decisions about their treatmentand care and greater continuity of care across the mental health services.More than a decade on, it remained unclear to what extent Irish mentalhealth services had progressed towards the modern, recovery orientatedsystem outlined in A Vision for Change (Department of Health, 2006).