Ouders met ernstige psychische aandoeningen; epidemiologische gegevens

ACHTERGROND Er is groeiende aandacht voor de hulpvragen rondom ouderschap van mensen met ernstige psychische aandoeningen. Weinig is echter bekend over de omvang van deze groep. DOEL Schatten van het aantal ouders van 18-64 jaar oud in Nederland met ernstige psychische aandoeningen, mede om het benodigde zorgaanbod te bepalen. METHODE Door het combineren van informatie uit epidemiologische studies werd een indicatie verkregen over het voorkomen van ouderschap bij mensen met ernstige psychiatrische aandoeningen. RESULTATEN Van alle patiënten met ernstige psychische aandoeningen had naar schatting 48% kinderen. De omvang van deze groep ouders was 0,9% van de bevolking tussen 18 jaar en 65 jaar en dit waren 68.000 mensen voor het jaar 2009. CONCLUSIE Bij bijna de helft van de mensen van 18-64 jaar met ernstige psychische aandoeningen dient de hulpverlening alert te zijn op potentiële behoefte aan ondersteuning bij het vervullen van de ouderrol. Betere registratie van mogelijke problemen in de ouder-kindrelatie is noodzakelijk voor een adequate sturing van het zorgaanbod, zowel op individueel als op macronivea

The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study

Three issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively ?" easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention - as compared to current best standard practice - will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimise

Routine Violence Risk Assessment in Community Forensic Mental Healthcare

We developed a method for periodic monitoring of violence risk, as part of routine community forensic mental healthcare. The feasibility of the method was tested, as well as its predictive validity for violent and risk enhancing behavior in the subsequent months. Participants were 83 clients who received forensic psychiatric home treatment, and six case managers. The method proved feasible and informative. Violent and risk enhancing behavior could be predicted to a reasonable extent (AUC = .77, 95% CI = .70-.85; respectively .76, .70-.82). Dynamic risk factors had an incremental predictive value over static factors in the prediction of violent behavior (OR = 4.30, 1.72-10.73). The professional judgment of the case managers added further predictive power (OR = 2.16, 1.40-3.33), corroborating the structured professional judgment approach. Finally, unmet needs for care of the client were associated with a reduced risk for violent and risk enhancing behavior (OR = .80, 0.69-0.93, and 0.84, 0.72-0.97). This latter finding suggests that in cases with unmet needs the case manager saw opportunities to do something about the risk. Currently we are testing whether using the method actually prevents violence. Copyright (C) 2009 John Wiley & Sons, Ltd

Role of the police in linking individuals experiencing mental health crises with mental health services

BACKGROUND: The police are considered frontline professionals in managing individuals experiencing mental health crises. This study examines the extent to which these individuals are disconnected from mental health services, and whether the police response has an influence on re-establishing contact. METHODS: Police records were searched for calls regarding individuals with acute mental health needs and police handling of these calls. Mental healthcare contact data were retrieved from a Psychiatric Case Register. RESULTS: The police were called upon for mental health crisis situations 492 times within the study year, involving 336 individuals (i.e. 1.7 per 1000 inhabitants per year). Half of these individuals (N=162) were disengaged from mental health services, lacking regular care contact in the year prior to the crisis (apart from contact for crisis intervention). In the month following the crisis, 21% of those who were previously disengaged from services had regular care contact, and this was more frequent (49%) if the police had contacted the mental health services during the crisis. The influence of police referral to the services was still present the following year. However, for the majority (58%) of disengaged individuals police did not contact the mental health services at the time of crisis. CONCLUSIONS: The police deal with a substantial number of individuals experiencing a mental health crisis, half of whom are out of contact with mental health services, and police play an important role in linking these individuals to services. Training police officers to recognise and handle mental health crises, and implementing practical models of cooperation between the police and mental health services in dealing with such crises may further improve police referral of individuals disengaged from mental health services