Community care for people with psychosis: Outcomes and needs for care
Department of Psychiatry, University of Melbourne, Australia. International Review of Psychiatry
(Impact Factor: 1.8).
05/2005; 17(2):89-95. DOI: 10.1080/09540260500074651
People with psychosis living in developed countries in the era of community-based care are likely to be socially isolated, unemployed, and have poor quality of life, despite recent advances in the treatment and understanding of psychosis. Recent work in Australia illustrates the needs for care, especially for those with complex disabilities, and even for those in contact with well-organized clinical mental health services. Insufficient evidence in two key areas impedes progress: the use of effective psychosocial interventions; and the impact of changes in the community care system. Follow-up studies of programs and interventions assessing a range of outcomes in local settings are now required to encourage professionals and the community to address these needs.
Available from: Penelope Fay Mitchell
- "Recent research in the fields of social and political psychology provides empirical support for the contention that attitudes anchored to well elaborated social representations and associated with strongly held values are not readily amenable to framing effects (Chong & Druckman, 2007; Sibley et al., 2006; Slothuus, 2008). One of the main factors that has driven opinion leaders in the mental health sector to call for greater intersectoral collaboration has been a perception that services in other sectors are not directing sufficient attention to the needs of clients with mental disorders (Chitsadesan & Bailey, 2006; Herrman & Harvey, 2005; King et al., 2006; Waghorn et al., 2004; Whiteford, 1994) and that an unacceptable proportion of people with mental health treatment needs are not being identified and referred to specialist services (Andrews, Henderson, & Hall, 2001; Chitsadesan & Bailey, 2006; Glazebrook, Hollis, Heussler, Goodman, & Coates, 2003; Harris & Edlund, 2005; Karlin & Fuller, 2007). Consistent with this view there has been a strong emphasis in the mental health literature over many years on increased identification through screening in order to increase rates of referral and treatment (Bailey & Tarbuck, 2006; Glazebrook et al., 2003; Harris & Edlund, 2005; Karlin & Fuller, 2007; Whiteford & Buckingham, 2005), and to facilitate prevention (Klein et al., 2001; Navon, Nelson, Pagano, & Murphy, 2001) as well as the development of more communitybased programs tailored to the special needs of clients with mental disorders (King et al., 2006; Waghorn et al., 2004). "
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ABSTRACT: Enhancing collaboration between specialist mental health services, primary health care and social care services has been a key priority in mental health policy reform in many countries for about 20 years and remains so. Yet progress in terms of widespread implementation of demonstrably effective models of collaborative care has been slow. The views that different providers hold regarding the parameters of their roles, and the values that guide their approach to service delivery, are likely to exert profound effects on engagement with collaborative initiatives. Little research has explored these issues. In this study, discourse analysis from a structurational perspective was used to explore the views of providers in a diverse purposive sample of non-medical primary health and social care services in the state of Victoria, Australia regarding their mental health care roles. Four interconnected discourses were revealed as supporting role positions constructed in opposition to the putative role positions of specialist mental health services: an informal as opposed to a formal approach; a normalising as opposed to a pathologising approach; holistic social and emotional health and wellbeing, and an individualised or client-focused model of care as opposed to an illness-focused model. These oppositional role constructions may contribute to reluctance among providers in these sectors to engage with some agendas being promoted by specialist mental health services, through either reduced self-efficacy or active resistance to innovations that conflict with strongly held values. Greater awareness of, and critical reflection upon, contrasting role constructions, and the implications of these for practice may facilitate the design of more appropriate collaborative models and stronger commitment to their implementation.
Social Science & Medicine 03/2009; 68(7):1213-20. DOI:10.1016/j.socscimed.2009.01.001 · 2.89 Impact Factor
Available from: Lisa Mary Brophy
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ABSTRACT: This research explores good practice with people on CTOs -via a case study of one area mental health service in Victoria. The emancipatory values of Social Work were used to guide the investigation, thereby ensuring the involvement of consumers and their families or carers. Critical Social Work theory provided an important theoretical base for the research, and both critical theory and pragmatism supported the methodology. A mixed methods approach was undertaken. This included a cluster analysis of 164 people on CTOs. Three clusters emerged from the exploratory cluster analysis. These clusters, labelled 'connected', 'young males' and 'chaotic' are discussed in relation to their particular characteristics. The results from the cluster analysis were used to inform the recruitment of four people on CTOs who were the central focus of case studies that represented the different clusters. Semi-structured group interviews were also undertaken to enhance the triangulation of data collection and analysis. This resulted in 29 semi-structured interviews with multiple informants, including consumers, family/carers, case managers, doctors, Mental Health Review Board members and senior managers. The data analysis was guided by a general inductive approach that was supported by the use of NVivo 7. Five principles, and the processes required to enable them, emerged from the qualitative data: 1) use and develop direct practice skills, 2) take a human rights perspective, 3) focus on goals and desired outcomes, 4) aim for quality of service delivery, and, 5) enhance and enable the role of key stakeholders. These principles are discussed and then applied to the case studies in order to consider their potential relevance to practice within a diverse community of CTO recipients. The application of the principles identified two further findings: 1) that the principles are interdependent, and 2) the relevance of the principles varies depending on the characteristics of the consumer. The two most important findings to emerge from this thesis are that: 1) people on CTOs, their family/carers, and service providers are a diverse community of people who have a range of problems, needs and preferences in relation to either being on a CTO or supporting someone on a CTO; and 2) the implementation of CTOs is influenced by social and structural issues that need to be considered in developing any recognition or understanding about what represents good practice. Recommendations relating to each of the principles are made, along with identification of future research questions. A particular focus is whether application of the principles will enable improvements in practice on a range of measures, including reducing the use of CTOs, and the experience of coercion by consumers.
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ABSTRACT: Most studies of outcome in schizophrenia have focused on incidence cohorts or samples identified through specialist mental health services; population-based samples provide a more complete picture of the effectiveness of community services.
To examine whether outcome predictors, derived from studies of selected patients with prolonged schizophrenia, would emerge in a largely community-dwelling population sample.
A follow-up sample of 114 adults with schizophrenia was identified via two censuses of key informants conducted for two prevalence surveys in North London, five years apart. Symptomatic, clinical and functional outcomes were assessed after five years. A composite score was derived for each individual. Multiple Linear Regression analyses were conducted in two phases to derive a best subset of predictors for global outcome.
After five years, 33% were worse and 62% were better overall. The four best predictors (social isolation, living apart from relatives, longer illness and being an inpatient at first census) accounted for 32% of the variance in outcome of those with schizophrenia and related diagnoses.
Social relationships during the course of illness are an important predictor of overall outcome and relationships with friends and family each seem to make a positive contribution. Policy and service developments should focus on improving participation in community life for people with schizophrenia, particularly their social connectedness.
International Journal of Social Psychiatry 08/2007; 53(4):340-56. DOI:10.1177/0020764006074529 · 1.15 Impact Factor
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