The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

<p>Abstract</p> <p>Background</p> <p>To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.</p> <p>The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.</p> <p>Methods</p> <p>Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.</p> <p>Results</p> <p>Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.</p> <p>Conclusion</p> <p>The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).</p

Mental health and employment: An overview of patterns and policies across Western Europe

Background: The relationship between mental health problems and employment is receiving growing attention across Europe as the cost of lost productivity is appreciated. Aims: This paper reports on the preliminary collection of data on employment of people with mental health problems and related economic issues in 17 countries participating in the Mental Health Economics European Network (MHEEN). Method: A questionnaire was developed with the Network partners and statistical and narrative data collected. These local and national level data were examined for patterns and trends. Results: Across Europe, the impact of mental health problems on lost productivity is substantial and growing. A range of policies have been developed to address this challenge, covering the spectrum of issues from workplace interventions promoting positive mental health to anti-discrimination laws to enable participation in the workforce. Conclusions: While much is being done, data and information on best practice across Europe are scarce. There is a need to share and collect this information to facilitate the sharing of best practice in Europe

Integrating organisation of healthcare services, workers' wellbeing, and quality of care:An introduction to the system-based perspective of healthy healthcare

The current chapter introduces Healthy Healthcare, an integrated perspective involving quality of care, workers' wellbeing, and organisation of healthcare services, for a system-based understanding of healthcare practice. Healthy Healthcare is based on three main conditions, herein termed pillars, of healthcare delivery: (a) quality of care; (b) workers' wellbeing; and (c) organisation of healthcare. This perspective is important to develop research approaches and to incorporate evidence-based practice and knowledge into Healthy Healthcare. The current volume provides perspectives on Healthy Healthcare based on research from different disciplines and different countries. This chapter introduces Healthy Healthcare with a brief presentation of the modern context of healthcare practice and a description and explanation of the system. It concludes with a brief outline of the volume's contents.</p

Implementing mental health economic evaluation evidence: Building a bridge between theory and practice

Background: Interest in economic evaluation to support strategic decision-making for mental health policy has increased, but the capacity for such analysis remains limited. Aims: To reflect on challenges faced in the production of economic evaluations and the extent to which they are used for mental health policy across Europe. Method: A bespoke questionnaire and literature review were used to collect information on the use of economic evaluation in 17 European countries. Results: The number of evaluations for mental health continues to grow; albeit their quality is patchy. Most concentrate on medications; there are few evaluations outside the health and social care sector. Simple cost-effectiveness analyses dominate, with much less use of cost-utility or cost-benefit analysis. Few have been subject to economic evaluation as part of reimbursement procedures for new drugs and other interventions. Conclusions: There is much scope for practical and methodological development, in particular on outcome measurement and the evaluation of complex non-health system interventions. The variable quality of evaluations suggests that work to build capacity for both their conduct and interpretation is needed. Initiatives such as MHEEN might help promote understanding of the potentially powerful role that can be played by economic evaluation

Meeting the challenge of funding and allocating resources to mental health across Europe: Developing the Mental Health Economics European Network

Aims - There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. Methods - Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. Results - Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no 'one size fits all solution. Conclusions - There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems

Moving beyond the mental health care system: An exploration of the interfaces between health and non-health sectors

Background: Many interventions both to promote good mental health and to tackle the consequences of poor mental health may be funded and/or delivered outside the health care sector. Aims: To describe the interfaces between health and other sectors, particularly social care, in 17 European countries, and to look at potential ways in which challenges to the efficient and fair delivery of services across sectors may be overcome. Methods: A structured questionnaire was completed by partners in the Mental Health Economics European Network (MHEEN) to review the extent to which mental health related services are funded and delivered outside the health care sector, with a particular emphasis on social care services. This was augmented by a review of the literature. Results: The boundaries between health and other sectors differ across and within countries. The provision and funding of services may be highly fragmented and poorly coordinated, with little incentive for funding to follow individuals along the care pathway. Out-of-pocket payments for non-health sector services can be substantial and much responsibility may fall to families. Conclusions: Differing rules of entitlement, as well as fragmentation and poor coordination between health and non-health services can act as barriers to a truly holistic approach to mental health across Europe. Useful insights on how to overcome some of these barriers may be drawn from experiences of joint working and innovative financing arrangements in respect of older people and those with physical disabilities. However as yet there have been comparatively few attempts to smooth the sector interfaces that confront those with mental health needs

Is it worth investing in mental health promotion and prevention of mental illness? A systematic review of the evidence from economic evaluations

Background. While evidence on the cost of mental illness is growing, little is known about the cost-effectiveness of programmes in the areas of mental health promotion (MHP) and mental disorder prevention (MDP). The paper aims at identifying and assessing economic evaluations in both these areas to support evidence based prioritisation of resource allocation. Methods. A systematic review of health and non health related bibliographic databases, complemented by a hand search of key journals and analysis of grey literature has been carried out. Study characteristics and results were qualitatively summarised. Economic evaluations of programmes that address mental health outcome parameters directly, those that address relevant risk factors of mental illness, as well as suicide prevention interventions were included, while evaluations of drug therapies were excluded. Results. 14 studies fulfilled the inclusion criteria. They varied in terms of topic addressed, intervention used and study quality. Robust evidence on cost-effectiveness is still limited to a very small number of interventions with restricted scope for generalisability and transferability. The most favourable results are related to early childhood development programmes. Conclusion. Prioritisation between MHP and MDP interventions requires more country and population-specific economic evaluations. There is also scope to retrospectively add economic analyses to existing effectiveness studies. The nature of promotion and prevention suggests that innovative approaches to economic evaluation that augment this with information on the challenges of implementation and uptake of interventions need further developmen

Is It Worth Investing in Mental Health Promotion and Prevention of Mental Illness? A Systematic Review of the Evidence from Economic Evaluations

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