Does mental health service integration affect compulsory admissions?

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. <br><br> Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991–1993 and 2001–2003. We included patients aged 18–60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. <br><br> Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. <br><br> Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions

Does mental health service integration affect compulsory admissions?

Abstract. BACKGROUND: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. METHODS: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. RESULTS: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. CONCLUSIONS: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions

Worldview Communication by Ritual Counsellors. An Explorative Multiple Case Study on Funeral Rituals

This contribution explores the question how ritual counsellors shape their hermeneutical-communicative role and how they use worldview communication in the preparation and performance of a funeral. Data were collected from a group of six ritual counsellors with a questionnaire and a group interview. The data were interpreted through the lens of three hermeneutical models. I come to the conclusion that respondents are aware of worldview aspects of their work, while they differ in the role they take. Some are more guides, others more witnesses. The role of priestess which some of the counsellors adopt deviates from the available professional theory. More reflection is needed to develop such a theory about worldview communication outside the church

Breakdown of continuity in public mental healthcare in the Netherlands: a longitudinal case study

<strong>Introduction:</strong> Continuity of care for long-term service-dependent patients in the public mental health system requires intensive collaboration between all agencies involved. Understanding the ways in which various aspects of continuity of care interact may reveal help to find out more about how care de­livered over time improves outcomes. <strong>C</strong><strong>ase study:</strong> Based on medical records, an addicted couple was monitored for number and type of contacts with health and social services. Over the years, 81 social workers or nurses, spread over 25 health and social services, have been involved in the rehabilitation process. Breakdown of continuity of care is linked to lack of information, missing procedures and guidelines, fragile relationships with the patient, and a reluctant public health approach. <strong>Conclu</strong><strong>sion: </strong>Prominent among relevant factors is the absence of protocols governing the transfer of patients between the various links in the continuum of mental healthcare services. High-quality follow-up after admission is partly a matter of professional principle in ensuring that problems in the chain of services are discussed. Case presen­tation in psychiatric journals should give syste­matic at­ten­tion to sources of error in continuity of mental health­care