Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy

Introduction: Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). Methods: Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. Results: Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). Conclusions: Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation

Development and validation of a new standardized measure for assessing experiences of discrimination within mental health services. A participatory research project

Aims: People with mental disorders frequently report experiences of discrimination within mental health services, which can have significant detrimental effects on individuals' well-being and recovery. This study aimed to develop and validate a new standardized measure aiming to assess experiences of stigmatization among people with mental disorders within mental health services. Methods: The scale was developed in Italian and tested for ease of use, comprehension, acceptability, relevance of items and response options within focus group session. A cross-sectional validation survey was conducted among mental health service users in Italy. Exploratory factor analysis with Promax oblique rotation, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient. Results: Overall, 240 people with mental disorders participated in the study; 56 also completed the retest evaluation after 2 weeks. The 18 items of the scale converged over a two-factor solution ('Dignity violation and personhood devaluation' and 'Perceived life restrictions and social exclusion'), accounting for 56.4% of the variance (KMO 0.903; Bartlett's test p < 0.001). Cronbach's alpha for the total score was 0.934. The scale showed one item with kappa above 0.81, four items between 0.61 and 0.80, ten items between 0.41 and 0.60, two items between 0.21 and 0.40 and only one item below 0.20. ICC was 0.928 (95% CI 0.877-0.958). Kendall's tau-b ranged from 0.450 to 0.617 (p < 0.001). Conclusions: The newly developed scale represents a valid and reliable measure for assessing experiences of stigma among patients receiving care within mental health services. The scale has provided initial evidence of being specifically tailored for individuals with psychotic and bipolar disorders. However, the factorial structure of the scale should be replicated through a confirmatory factor analysis on a larger sample of individuals with these conditions

Performance and effectiveness of step progressive care pathways within mental health supported accommodation services in Italy

Background: In Italy, a growing number of people with severe mental illness (SMI) require care in residential facilities (RFs), a key component of the care pathway. However, despite their development, studies about resident samples have been very few. Aims: This study, the VALERE-REC Study (eVALuation of outcomE in Residential-use of clinical data with REsearch objeCtives) aims to identify the characteristics that increase the probability to move patients living in RFs to a more independent setting. Methods: A survey involved 167 patients hosted in 25 RFs of the Verona Mental Health Department. Forty-five patients were residents (27%) in Comunità Terapeutico Riabilitativa Protetta (CTRP); 56 (34%) in Comunità Alloggio (CA), 14 (8%) in Gruppo Appartamento Protetto (GAP), 52 (31%) in Comunità Alloggio Estensiva (CAE). They were assessed for their care pathway after 30-months. The Quality Indicators for Rehabilitative Care-Supported Accommodation (QuIRC-SA) evaluated the quality of 19/25 (76%) RFs. Descriptive analyses were done. Results: According to the mission stated by the Veneto Region guidelines, RFs hosted patients with different needs and clinical profiles. The mean stay was longer than expected, most patients were unemployed, unmet needs were related to self-management and patient's social contacts, and recovery-oriented practices were not implemented. Conclusions: Despite the appropriate admission of patients in different RFs considering their psychopathology, functioning, and needs, the progressive step care pathway did not result effectively pursued. To improve the effectiveness of residential interventions a major task should be to focus on the acquisition of the necessary skills to live independently

Proprietà psicometriche della Scheda di Monitoraggio del Percorso Riabilitativo (MPR). [Psychometric properties of the Monitoring of the Path of Rehabilitation (MPR) Form.]

Scopo. Il corretto inserimento degli individui con disturbi mentali nelle strutture residenziali psichiatriche (SRP) e il monitoraggio del loro percorso nelle stesse risulta una criticità non compiutamente risolta del sistema italiano. Per ovviare a tale criticità si utilizzano alcuni strumenti validati che per lo più valutano il funzionamento/disabilità del paziente in setting aspecifico, mentre nella platea internazionale non sono stati predisposti strumenti che valutino l’autonomia funzionale dei pazienti psichiatrici ospiti in SRP. Il Dipartimento di Salute Mentale di Verona ha creato la Scheda di Monitoraggio del Percorso Riabilitativo (MPR) con l’obiettivo di valutare l’autonomia funzionale dei pazienti per inserirli e monitorarli adeguatamente nei loro percorsi residenziali. L’obiettivo di questo studio è testare le principali proprietà psicometriche della Scheda MPR. Metodi. Lo studio delle proprietà psicometriche della Scheda MPR è stato articolato in tre passaggi: una valutazione condotta a distanza di più di 15 giorni da due valutatori indipendenti su 18 casi clinici per indagare la riproducibilità dello strumento (test-retest); un test dei 18 casi clinici da parte dei due valutatori per misurare la concordanza tra valutatori (inter-rater); una misurazione della validità concorrente utilizzando la Scala di Funzionamento Personale e Sociale. Otto professionisti hanno compilato un questionario di gradimento inerente all’accettabilità della Scheda MPR. Le analisi di inter-rater e di test-retest sono state condotte utilizzando coefficienti di correlazione intraclasse. La validità concorrente è stata studiata tramite il coefficiente di correlazione tau-b rank di Kendall e l’accettabilità tramite un’analisi delle frequenze. Risultati. L’affidabilità inter-rater e test-retest sono risultate buone, così come la validità concorrente e l’accettabilità. Conclusioni. I dati presentati in questo articolo dimostrano che è possibile misurare l’autonomia funzionale dei pazienti ospiti nelle SRP italiane utilizzando la Scheda MPR.Purpose: The correct placement of people with mental disorders in psychiatric residential facilities (PRF) and the monitoring of their progress in these facilities is a critical issue that has not been fully settled in the Italian system. To overcome this problem, some validated instruments are used, which mostly assess the patient's functioning/disability, while no instruments have been set up to assess functional autonomy in patients with a psychiatric disorder residents in RFs. The Verona Department of Mental Health has created the Monitoring of the Path of Rehabilitation (MPR) Form with the aim of assessing the functional autonomy of patients to admit and monitor them adequately in their residential pathways. The aim of this study is to test the main psychometric properties of the MPR Form. Methods: The study of the psychometric properties of the MPR Form consisted of three steps: an evaluation conducted more than 15 days apart by two independent evaluators on 18 clinical cases to investigate the test-retest reliability; a test of the 18 clinical cases by the two evaluators to measure the inter-rater rieliability; a measure of convergent validity using the Personal and Social Functioning Scale. Eight professionals completed a satisfaction questionnaire regarding the acceptability of the MPR Form. Inter-rater and test-retest analyses were conducted using intraclass correlation coefficients. Convergent validity was investigated using Kendall's tau-b rank correlation coefficient and acceptability using a frequency analysis. Results: Inter-rater and test-retest reliability were good, as well for concurrent validity and acceptability. Conclusions: The data presented in this article demonstrate that it is possible to measure the functional autonomy of patients in Italian SRPs using the MPR Form

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services