This study examined (1) disparities in the proportion of persons who accessed a physician for treatment of a diagnosed mental disorder across 17 health regions in Alberta, Canada, and (2) the extent to which regional disparities in physician access could be explained by differences in regional demographies, population needs, or physician supply.
The study illustrates the use of ecological comparisons for regional health system performance evaluations. Regional characteristics were aggregated from four sources of data: the health insurance registry file (population denominators and regional demographies), physician claims data (treatment access), census data (social indicators of population need), and the medical directory of the College of Physicians of Surgeons (physician supply).
Regional variability in needs-adjusted measures of access to physician-based treatment services were comparatively small (varying by a factor of 1.6). Models containing adjustments for demography, need, and physician supply explained 41% of regional variation in access. Of the total variation explained, physician supply explained a smaller proportion (39%) in comparison to social demography and needs (61%). Few large regional imbalances were noted when needs-adjusted and supply-adjusted estimates were compared. Only two areas appeared to be underserviced in comparison to their local needs, reflecting approximately 6% of the provincial population.
While all three study factors proved important, findings support the broad conclusion that social demography and social risk (a proxy for need) will remain the key determinants predicting access to physician services for treatment of mental disorders in publicly funded health systems.
BACKGROUND: Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. MATERIAL AND METHODS: The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. RESULTS: 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). INTERPRETATION: None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.
The Plan d'action en santé mentale 2005-2010 commands a substantial reform of mental health services organization. In order to achieve this, the Plan draws upon a set of ideas that appear somewhat unsubstantiated in regards to the sciences of organization. This article examines a few of these ideas. The managerial rhetoric of the Plan is anchored in an organizational and mechanistic archetype known for its inadequacy in the central mission of organizations of complex human services such as those concerning mental health. The mechanist rationality adopted marginalizes the real source of the value of mental health services, of practitioners and their social institutions. It participates in a movement that renders organizations always bigger, more abstract and impersonal steered from a distance by superficial indicators. There are good reasons to believe that this approach of organizational engineering will accentuate the eroding of the individual and collective capacities of delivering services of great value.
The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014.
This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings.
The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working.
Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
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A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out.
The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre.
Concerns still exist among lesbian-, gay-, bisexual-, transgendered-, and queer-identified individuals (LGBTQ individuals) about their reception and treatment by psychiatric service providers. The Psychiatric Service at the University of Toronto and the Office of LGBTQ Resources and Programs convened a committee to address expanding the capacities of the Service related to the needs of LGBTQ and questioning students. In this paper, we describe the committee's role, initiatives, and successes and discuss challenges encountered in the process. The model of community development drawn from in this work can be adapted for use in other community health settings.