Effectiveness of the Outpatients Services in Georgia

Georgia has made a commendable effort to reform mental health care recently. The 'Concept on Mental Health Care' adopted by the Government and two strategic plans for 20142020 and 2021-2031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted deinstitutionalization and development of community mental health services. Since 2018 new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state program and funded accordingly. The initiation of new standards for ambulatories and mobile teams increased access and coverage of mental health care across the country. However still, further effort is needed to achieve a comprehensive treatment in mental health care services.

Community Mental Health Services in Greece: development, challenges and future directions

The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social care services, and to ensure that service development is driven by need. Crucially, such aims demand the adoption of a culture of clinical governance and a consistent shift from traditional therapeutic care to person-centered psychiatry and preventive psychiatry.

Practice Nurses Educational Needs in Mental Health: a Descriptive Exploratory Survey

<p>Background-Large numbers of patients see practice nurses (PNs) daily for their health care. Many of these patients will have a mental illness or a mental health (MH) need. International research suggests that the practice nurses are undertaking mental health assessment and interventions without the requisite skills and knowledge. This thesis reports on a study designed to quantify PNs work in mental health, to determine their education requirements and establish their confidence in the field of mental health. Methods-A postal survey was used to examine the nature of MH problems encountered by PNs, describe the MH interventions currently being used by them and identify the perceived learning needs of PNs in MH. Practice nurses in Hawkes Bay and Tairawhiti regions were surveyed. The questionnaire consisted of 33 open, closed and likert questions. Analysis was by descriptive, correlation and inferential statistics plus content analysis for open questions. Findings-52 respondents completed the questionnaire and the results demonstrate that these PNs are caring for patients with an extensive range of mental health concerns daily. Most common are people with depression and anxiety. The nurses perform a wide range of MH interventions such as counselling and advice on medication and have minimal confidence in their skill level. The nurses expressed learning needs included recognition and management of a wide range of mental health conditions such as suicidal ideation and all types of depression, reflecting the range of conditions met. Other learning requirements included understanding of co-morbidity and how to screen for mental health. The preferred provider of education was community mental health services by means of a short course specifically designed to meet their needs. Discussion-Practice nurses require education and support specifically designed to meet their identified needs in mental health to help then improve the care to patients. This will require collaboration between secondary mental health services, primary mental health nurses and tertiary institutions. With targeted education these nurses should become more confident and competent in their dealings with people who present to their practice with a mental health concern.</p>

Practice Nurses Educational Needs in Mental Health: a Descriptive Exploratory Survey

<p>Background-Large numbers of patients see practice nurses (PNs) daily for their health care. Many of these patients will have a mental illness or a mental health (MH) need. International research suggests that the practice nurses are undertaking mental health assessment and interventions without the requisite skills and knowledge. This thesis reports on a study designed to quantify PNs work in mental health, to determine their education requirements and establish their confidence in the field of mental health. Methods-A postal survey was used to examine the nature of MH problems encountered by PNs, describe the MH interventions currently being used by them and identify the perceived learning needs of PNs in MH. Practice nurses in Hawkes Bay and Tairawhiti regions were surveyed. The questionnaire consisted of 33 open, closed and likert questions. Analysis was by descriptive, correlation and inferential statistics plus content analysis for open questions. Findings-52 respondents completed the questionnaire and the results demonstrate that these PNs are caring for patients with an extensive range of mental health concerns daily. Most common are people with depression and anxiety. The nurses perform a wide range of MH interventions such as counselling and advice on medication and have minimal confidence in their skill level. The nurses expressed learning needs included recognition and management of a wide range of mental health conditions such as suicidal ideation and all types of depression, reflecting the range of conditions met. Other learning requirements included understanding of co-morbidity and how to screen for mental health. The preferred provider of education was community mental health services by means of a short course specifically designed to meet their needs. Discussion-Practice nurses require education and support specifically designed to meet their identified needs in mental health to help then improve the care to patients. This will require collaboration between secondary mental health services, primary mental health nurses and tertiary institutions. With targeted education these nurses should become more confident and competent in their dealings with people who present to their practice with a mental health concern.</p>

Explicit and implicit attitudes toward people with COVID-19: Need for community mental health services

During the course of the COVID-19 pandemic, social stigmatization of people who have been infected with the virus has been observed. This study measured the degree of social stigma by examining implicit and explicit attitudes toward people with COVID-19. Explicit attitudes were measured through self-reporting, taking into account the three components of behavior, cognition, and emotion, and we used the Single-Category Implicit Association Test to assess implicit attitudes. The findings show that explicit attitudes toward people with COVID-19 were positive, whereas implicit attitudes trended toward being negative. The results suggest that mental health services and policies are needed to reduce social stigma and prevent the risk of mental health problems among people who have been infected with COVID-19.

Impact of lockdown due to COVID-19 pandemic on psychiatric patients

Background: There was sudden reorganization of services during lockdown due to COVID-19. Care of psychiatric patients was in threat due to closure of inpatient department and conversion of hospitals into COVID treatment centres.Methods: List of follow-up patients not attending our outpatient department during lockdown was obtained. They were contacted through telephone. Evaluation was done with Brief psychiatry rating scales (BPRS) and WHODAS2 scales. Statistical analysis of obtained data was done.Results: Comparison of BPRS total score, WHODAS domain scores and total score between outpatients and inpatients was done using independent samples ‘t’ test. It was found to be statistically significant (p<0.05). Anxiety and distractibility are the more prominent symptoms in majority of psychiatry patients.Conclusions: Psychiatric patients needs safe place, with people to talk and to take care of daily activities. It is highly recommended urgent need of creating awareness program on COVID-19 pandemic which targets this vulnerable population. It is essential to provide continued psychiatric intervention using tele-psychiatric platform and ensure their social support using community mental health services during the pandemic. A standard protocol on the management of patients with serious mental illness during an infectious disaster should be developed.

An International Pilot Study of Self-Reported Quality of Life in Outpatient and Inpatient Mental Health Settings

Introduction: Measuring quality of life (QoL) is essential to understand how clients perceive their care. In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there are fewer standardized instruments to routinely collect information about self-reported QoL, especially across different mental health settings. Moreover, existing tools have been criticized for being built from the perspective of care professionals rather than the users' perspective. The 23-item Self-Reported interRAI-QoL Survey for Mental Health and Addictions (interRAI SQoL-MHA) tackles these issues, as it is based on self-reported measures and has proven validity across settings and countries.Objective: The aim of this study is to assess and compare QoL across settings and explore associations between dimensions of self-reported QoL and some items from the interRAI SQoL-MHA in a multinational sample.Settings: Inpatient and community mental health services.Methods: Data were collected from organizations in Belgium, Finland, Russia, Brazil, Rwanda, Canada and Hong Kong. Logistic regression models were constructed using each domain scale of the interRAI SQoL-MHA (relationship, support, hope, activities and relationship with staff) as dependent variables.Results: A total of 2,474 people (51.2% female, 56.7% of age 45 or older) were included in the study. A benchmark analysis showed the samples that performed above the benchmark line or below. The models yielded significant odds ratios among the domain scales, as well as for the items of the interRAI SQoL-MHA, with positive associations for the items “work and education opportunities” and “satisfied with services”, and inverse associations for the items “financial difficulties” and for the inpatient setting.Conclusion: The analysis of associations between the determinants offers relevant information to improve mental health care and clients' perceived quality of life. Information about the determinants can help policymakers to design interventions to improve care outcomes, as well as provide more possibilities for integration into the community. The interRAI SQoL-MHA is innovative, as it can be linked to the third generation interRAI MH and Community MH-instruments, to be used in different mental health care settings, combining the objective and subjective QoL domains.