“It’s a matter of building bridges…” – feasibility of a carer involvement intervention for inpatients with severe mental illness

Background Family and friends (carer) involvement in the treatment of people with mental illness is widely recommended. However, the implementation remains poor, especially during hospital treatment, where carers report being excluded from care decisions. Methods We developed structured clinical procedures to maximise carer involvement in inpatient treatment. The aim of this study was to test their feasibility across four inpatient wards in East London and explore experiences of the participants. The intervention was delivered by clinicians (social therapists, nurses and psychiatrists) who were trained by the research team. Thirty patients and thirty carers received the intervention and completed research assessments and qualitative interviews after the intervention. 80% of the patients were followed up after six weeks of admission to complete quantitative questionnaires. Six clinicians were interviewed to explore their views on the intervention. Thematic analysis was used to analyse qualitative data. Results The intervention was found to be feasible to be delivered within the first week of admission in more than a half of the patients (53%) who provided consent. The main reasons why the interventions was not delivered in the remaining 47% of patients included staff or carers not being available, withdrawal of consent from the patient or patient being discharged prior to the intervention. Two themes were identified through thematic analysis. The first captured participant experiences of the intervention as facilitating a three-way collaborative approach to treatment. The second covered how patients’ mental states and practicalities of inpatient care acted as barriers and facilitators to the intervention being implemented. Conclusions Carer involvement in hospital treatment for mental illness is more difficult to implement than is commonly thought. This study has shown that a simple structured approach can facilitate a trialogue and that patients, clinicians and carers appreciate this approach to care. Our intervention provides clear and simple manualised clinical procedures that clinicians can follow. However, even the implementation of such procedures may be challenging in the absence of wider organisational support. The involvement of senior managers and clinical leaders might play a key role in overcoming barriers and support front-line clinicians to prioritise and implement carer involvement

Baseline utilisation of specialist disability services in Ireland. ESRI Working Paper No.644 December 2019

The objective of this paper is to analyse the data on specialist disability services available in Ireland. The paper provides a baseline utilisation profile of selected services which can be used to project future service demand and expenditure. The limitations of the currently available data in providing a comprehensive picture of specialist disability services in Ireland are also outlined

Giving patients choices during involuntary admission : a new intervention

Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients’ experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise). Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients (N = 14) and clinicians (N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis. Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients’ and clinicians’ experiences of the intervention fall into two themes: ‘Enabling a different dynamic’ and ‘Clashing with usual practices and priorities’. Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment

Reflections on Poverty Assessments in Papua New Guinea, Fiji and Vanuatu

Poverty, vulnerability and corruption are not new or unique to the South Pacific, but the lack of capacity of governments to govern has seriously affected households and communities already on the edge of poverty. In Papua New Guinea, the general deterioration in government services and in transport and communication infrastructure, has increased the economic and social marginalisation of many isolated communities. The recent poverty assessments in Papua New Guinea, Fiji and Vanuatu outline a number of strategies to assist those living in, or on the edge of poverty, but these will only be successful if accompanied by strategies to achieve more effective and equitable governance

An Uneasy Relationship

The situation of Norfolk Island, as a territory of the Commonwealth of Australia, is one of the historical anomalies in governance, which has persisted since 1914. It reflects the direct historical linkages between the British Crown and those Norfolk Islanders who were descendants of Pitcairn Islanders of Mutiny on the Bounty fame. Yet, once Federation was in the wind, the British Government, against the expressed wishes of the Norfolk Island community, sought to divest itself of all responsibility for Norfolk Island. There is a curiously ‘Yes Minister’ quality about the negotiations which lead to the final take-over by Australia, and the appointment of the first Commonwealth Administrator of Norfolk Island. The direct involvement of Atlee Hunt, then Secretary of the Department of External Affairs, eventually ensured the appointment of Michael Vincent Murphy. In order to achieve this end, Hunt had to fend off other applicants who were busy ingratiating themselves with the Minister for External Affairs Patrick McMahon Glynn and the then Prime Minister Joseph Cook. This is essentially a study of the relationships between governors, politicians, public servants and community leaders during the years which followed the take-over of Norfolk Island, and of the struggle of one Norfolk Islander, Charles Chase Ray Nobbs, against Australian administrative authorit

GEOGRAPHIC PROFILE OF HEALTHCARE NEEDS AND NON-ACUTE HEALTHCARE SUPPLY IN IRELAND. ESRI RESEARCH SERIES NUMBER 90 JULY 2019

This report provides evidence on the supply of and need for non-acute primary, community and long-term care across geographic areas in Ireland in 2014. This is the first report to be published from the Health Research Board-funded project ‘An inter-sectoral analysis by geographic area of the need for and the supply and utilisation of health services in Ireland’. This report provides the most comprehensive evidence on the geographic distribution of primary, community and long-term care supply to have been published for Ireland to date. Overall, the report finds significant inequalities in the supply of primary, community and longterm care services across counties in Ireland.1 The findings have important implications for future planning of the Irish health system. The overall objective of the project is to provide evidence to inform policymakers about the shift of care, where appropriate, from the acute hospital setting to nonacute care settings. This project is undertaken in the context of significant system reforms in recent years that aimed to, among other things, achieve greater integration in the Irish healthcare system via shifting care, where appropriate, from acute to non-acute settings and building capacity in primary, community and longterm care. The project sets out to provide detailed evidence on supply of services in the non-acute sector, compares supply across regions to identify where nonacute care supply is particularly scarce, and provides evidence on how acute and non-acute services interact, and substitute, within the Irish health and social care system. Evidence generated from this project is of particular relevance in the context of the current Sláintecare strategy (Houses of the Oireachtas Committee on the Future of Healthcare, 2017), a cross-party plan aimed at delivering sustainable and equitable health and social care services in Ireland

Unmet healthcare needs in Ireland. ESRI Research Bulletin 2016/06

Relatively high user charges for GP consultations (for those without a medical/GP visit card) and long waits for public hospital services can act as barriers to accessing needed care in Ireland. However, there has been relatively little research on unmet healthcare needs in Ireland. In 2014, approximately 38 per cent of the population had a medical card, while 3.5 per cent had a GP visit card. Cardholders are eligible for GP care without fees and there has been previous evidence that non-cardholders may not visit a GP because of cost (O’Reilly et al. 2007). Approximately 42 per cent of the population hold private health insurance, which is mainly used to provide cover for private or semi-private acute hospital services, thereby avoiding potentially long waits for public hospital services. While those with a medical card can purchase private health insurance, the numbers doing so are relatively small. There is also a group of people without private health insurance and/or a medical card. This paper examines how these differing levels of cover for medical care may affect the experience of unmet need for care in Ireland

BUDGET PERSPECTIVES 2017, PAPER 1. Challenges in Achieving Universal Healthcare in Ireland. June 2016

The World Health Organization has advocated universal healthcare as the best means of improving global health. However achieving universal healthcare is not without challenges: from defining the goal of universal healthcare to identifying the most appropriate methods to achieve it. Ireland is unique in the EU in not having universal coverage of primary care. In 2011, a newly-elected government committed to the development of a universal, single-tier health service, to be financed by a new system of Universal Health Insurance (UHI) provided by multiple, competing private insurers. A White Paper published in 2014 outlined the proposed UHI model. However, in 2015 in response to publication of a study of the potential cost implications of the proposed UHI model, the Government abandoned this model

How does Irish Healthcare Expenditure compare internationally? ESRI Research Series 114 October 2020.

The ESRI research report ‘How does Irish Healthcare Expenditure compare internationally?’ examines how Irish Healthcare Expenditure (HCE) compares to expenditure in other countries. Using international OECD data for 2017, this study finds that how Irish HCE compares differs depending on the expenditure measure used, the service examined and whether the comparison is adjusted for countries’ differing approaches to accounting for Social Care Expenditure