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

Implementing the flexible ACT model in an Italian residential facilities multidisciplinary team

[no abstract available

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

Uncertainty Work:Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams

The quest for how to deal with a crisis in a community setting, with the aim of deinstitutionalizing mental health care, and reducing hospitalization and coercion, is important. In this article, we argue that to understand how this can be done, we need to shift the attention from acute moments to daily uncertainty work conducted in community mental health teams. By drawing on an empirical ethics approach, we contrast the modes of caring of two teams in Utrecht and Trieste. Our analysis shows how temporality structures, such as watchful waiting, are important in dealing with the uncertainty of a crisis.</p

Uncertainty Work:Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams

The quest for how to deal with a crisis in a community setting, with the aim of deinstitutionalizing mental health care, and reducing hospitalization and coercion, is important. In this article, we argue that to understand how this can be done, we need to shift the attention from acute moments to daily uncertainty work conducted in community mental health teams. By drawing on an empirical ethics approach, we contrast the modes of caring of two teams in Utrecht and Trieste. Our analysis shows how temporality structures, such as watchful waiting, are important in dealing with the uncertainty of a crisis.</p

Histories of Social Functioning and Mental Healthcare in Severely Dysfunctional Dual-Diagnosis Psychiatric Patients

Abstract Disengagement from mental health services is a major obstacle to the treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder). A subgroup of these patients is considered to be treatment resistant and we aim to explore whether patients’ reasons for disengagement may stem from negative experiences in their lives and treatment histories. This retrospective, explorative study examined the medical files of 183 severely dysfunctional dual-diagnosis patients who had been admitted involuntarily to a new specialized clinic for long-term treatment. Most patients shared common negative experiences with respect to childhood adversities, low school achievement, high levels of unemployment, discontinuity of care, and problems with the judicial system. The lifetime histories of treatment-resistant, severely dysfunctional dual-diagnosis patients showed a common pattern of difficulties that may have contributed to treatment resistance and disengagement from services. If these adversities are targeted, disengagement may be prevented and outcome improved

Illness Management & Recovery (IMR) in the Netherlands; a naturalistic pilot study to explore the feasibility of a randomized controlled trial

Multivariate analysis of psychological dat