Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

<p>Abstract</p> <p>Background</p> <p>The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.</p> <p>Methods</p> <p>167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.</p> <p>Results</p> <p>We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.</p> <p>Conclusion</p> <p>The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.</p

Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice : the VELO study

Background: The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs. Methods: 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression. Results: We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression. Conclusion: The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed

Time-trends in the utilization of decentralized mental health services in Norway - A natural experiment: The VELO-project

<p>Abstract</p> <p>Background</p> <p>There are few reports on the effects of extensive decentralization of mental health services. We investigated the total patterns of utilization in a local-bed model and a central-bed model.</p> <p>Methods</p> <p>In a time-trend case-registry design, 7635 single treatment episodes, from the specialist and municipality services in 2003-2006, were linked to 2975 individual patients over all administrative levels. Patterns of utilization were analyzed by univariate comparisons and multivariate regressions.</p> <p>Results</p> <p>Total treated prevalence was consistently higher for the central-bed system. Outpatient utilization increased markedly, in the central-bed system. Utilization of psychiatric beds decreased, only in the central-bed system. Utilization of highly supported municipality units increased in both systems. Total utilization of all types of services, showed an additive pattern in the local-bed system and a substitutional pattern in the central-bed system. Only severe diagnoses predicted inpatient admission in the central-bed system, whereas also anxiety-disorders and outpatient consultations predicted inpatient admission in the local-bed system. Characteristics of the inpatient populations changed markedly over time, in the local-bed system.</p> <p>Conclusions</p> <p>Geographical availability is not important as a filter in patients' pathway to inpatient care, and the association between distance to hospital and utilization of psychiatric beds may be an historical artefact. Under a public health-insurance system, local psychiatric personnel as gatekeepers for inpatient care may be of greater importance than the availability of local psychiatric beds. Specialist psychiatric beds and highly supported municipality units for people with mental health problems do not work together in terms of utilization. Outpatient and day-hospital services may be filters in the pathway to inpatient care, however this depends on the structure of the whole service-system. Local integration of psychiatric services may bring about additive, rather than substitutional patterns of total utilization. A large proportion of decentralized psychiatric beds may hinder the development of various local psychiatric services, with negative consequences for overall treated prevalence.</p

Vann, juss og samfunn

Society’s use and management of water relies on professional expertise spanning diverse fields: from biology and technology to economics and law. This book examines current issues related to regulating water through chapters summarizing various sets of regulation as well as chapters that take a scientific deep dive into selected themes. The diversity of professional expertise is also reflected in the law aspect. We explore such subjects as surface runoff, natural disasters, drinking water, groundwater, salmon, hydropower, and human rights, as well as general impact assessment requirements and duty of knowledge in environmental law administration. A key objective of the book has been to provide an interdisciplinary understanding of the legal circumstances associated with water, and in addition, deliberate the pros and cons of some of the current regulations. This book will be particularly useful for those who in various ways support and facilitate procedures within the public sector at both the national and municipal levels. It will also be useful for private sector actors seeking familiarity with legal questions that can arise in relation to public administration and other private actors. From a broader perspective, we hope the book can help to throw light on conflicts between different interests and groups within society that occur, for example, when introducing fees, special injunctions against private actors, and requirements for knowledge basis. This book project is the result of legal research conducted at the Norwegian University of Life Sciences (NMBU) and is supplemented by national expertise in several areas. It has been edited by Steinar Taubøll, a professor at NMBU’s Department of Property and Law. Taubøll has a background in both law and the natural sciences, and extensive experience with interdisciplinary work.Håndtering og bruk av vann i samfunnet krever et faglig mangfold fra biologi og teknikk til økonomi og juss. Denne boken drøfter aktuelle temaer knyttet til rettslig regulering av vann, både i form av oversiktskapitler om ulike regelsett og gjennom vitenskapelige dypdykk i utvalgte temaer. Den faglige spennvidden gjenspeiler seg også innen det juridiske. I boken finner man stoff om overvannshåndtering, naturfare, drikkevann, grunnvann, villaks, kraftutbygging, menneskerettigheter, samt om generelle utredningskrav og kunnskapsplikter i miljørettsforvaltning. Et sentralt siktemål er å bygge opp tverrfaglig forståelse av gjeldende juridiske forhold knyttet til vann, og dessuten sette noen av dagens reguleringer under debatt. Boken retter seg særlig til de ressurspersonene som på ulike måter støtter saksbehandlingen i stat og kommune. Boken antas også å være nyttig for private aktører som vil gjøre seg mer kjent med rettsspørsmål som kan oppstå i forhold til forvaltningen og til andre private aktører. I et bredere perspektiv er det dessuten ønskelig at boken kan bidra til å belyse konflikter mellom ulike hensyn og grupper i samfunnet, for eksempel ved innføring av gebyrer, pålegg rettet mot private, innføring av tyngende vilkår og krav til kunnskap og faktagrunnlag. Bokprosjektet springer ut av den juridiske forskningen ved Norges miljø- og biovitenskapelige universitet, og har i tillegg knyttet til seg nasjonal spisskompetanse på mange temaer. Bokas redaktør er dosent Steinar Taubøll ved Institutt for eiendom og juss ved NMBU, som har naturfaglig og juridisk utdannelse, samt lang erfaring med tverrfaglig arbeid

Vann, juss og samfunn

Society’s use and management of water relies on professional expertise spanning diverse fields: from biology and technology to economics and law. This book examines current issues related to regulating water through chapters summarizing various sets of regulation as well as chapters that take a scientific deep dive into selected themes. The diversity of professional expertise is also reflected in the law aspect. We explore such subjects as surface runoff, natural disasters, drinking water, groundwater, salmon, hydropower, and human rights, as well as general impact assessment requirements and duty of knowledge in environmental law administration. A key objective of the book has been to provide an interdisciplinary understanding of the legal circumstances associated with water, and in addition, deliberate the pros and cons of some of the current regulations. This book will be particularly useful for those who in various ways support and facilitate procedures within the public sector at both the national and municipal levels. It will also be useful for private sector actors seeking familiarity with legal questions that can arise in relation to public administration and other private actors. From a broader perspective, we hope the book can help to throw light on conflicts between different interests and groups within society that occur, for example, when introducing fees, special injunctions against private actors, and requirements for knowledge basis. This book project is the result of legal research conducted at the Norwegian University of Life Sciences (NMBU) and is supplemented by national expertise in several areas. It has been edited by Steinar Taubøll, a professor at NMBU’s Department of Property and Law. Taubøll has a background in both law and the natural sciences, and extensive experience with interdisciplinary work