Subject(s)
Delivery of Health Care, Integrated/organization & administration , Mental Disorders/therapy , National Health Programs , Private Practice/organization & administration , Budgets/organization & administration , Community Psychiatry/economics , Community Psychiatry/organization & administration , Contract Services/economics , Contract Services/organization & administration , Cost-Benefit Analysis , Delivery of Health Care, Integrated/economics , Germany , Hospital Costs/organization & administration , Insurance Coverage/economics , Insurance Coverage/organization & administration , Interdisciplinary Communication , Intersectoral Collaboration , Marketing of Health Services/economics , Marketing of Health Services/organization & administration , Mental Disorders/economics , National Health Programs/economics , Private Practice/economics , Psychotherapy/economics , Psychotherapy/organization & administration , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/organization & administrationABSTRACT
The post-war phase of the deinstitutionalisation of psychiatry, which led to the legal recognition of the sector, has been followed by the years of economic crisis. As in the past, such times favour the exclusion of the weakest. As resources dwindle, only the clinical meaning, the dynamism and creativity of the nursing teams can ensure the emergence of new solutions for complex care situations.
Subject(s)
Community Psychiatry/organization & administration , Cooperative Behavior , Interdisciplinary Communication , Mental Disorders/nursing , Nursing, Team/organization & administration , Persons with Mental Disabilities/rehabilitation , Psychiatric Nursing/organization & administration , Community Psychiatry/economics , Cost Savings , Deinstitutionalization/economics , Deinstitutionalization/organization & administration , France , Humans , Nursing, Team/economics , Psychiatric Nursing/economics , Social Adjustment , Social StigmaABSTRACT
The health economic evaluation of community mental health interventions can contribute to an optimization of the allocation of mental health care resources. Existing studies on the health economic evaluation of community mental health interventions include a wide range of treatment options from the deinstitutionalization of long-term inpatients into community-based services to specialized services for specific patient groups. The results of these studies indicate that community-based mental health care is not generally less costly in comparison to more institutionalized forms of care. Programs that are based on the ACT approach have been found to be more efficient than inpatient care. Compared to the current standard of mental health care in most western European countries, an intensification of community mental health interventions could increase the efficiency of psychiatric treatment especially for heavy users and first episode patients. However, methodological flaws and a lack of national studies limit the validity of current health economic investigations, particularly for Germany.
Subject(s)
Community Psychiatry/economics , Health Care Costs/statistics & numerical data , Mental Disorders/economics , Mental Disorders/therapy , Psychotherapy/economics , Germany/epidemiology , Humans , Mental Disorders/epidemiology , PrevalenceSubject(s)
Ambulatory Care/legislation & jurisprudence , Community Psychiatry/legislation & jurisprudence , Cooperative Behavior , Interdisciplinary Communication , Mental Disorders/rehabilitation , National Health Programs/legislation & jurisprudence , Patient Care Team , Ambulatory Care/economics , Chronic Disease , Combined Modality Therapy/economics , Community Psychiatry/economics , Cost Control/legislation & jurisprudence , Germany , Health Services Research , Humans , Mental Disorders/economics , National Health Programs/economics , Patient Care Team/economics , Rehabilitation, Vocational , Self Care/economics , Social Security/economics , Social Security/legislation & jurisprudence , Socioenvironmental Therapy/economics , Socioenvironmental Therapy/legislation & jurisprudence , Treatment FailureABSTRACT
Demographic change, limited financial resources and increasing social exclusion of individuals suffering chronic illness are major challenges for health and social systems in general and for psychiatry in particular. The paper analyses to what extent social psychiatric research currently addresses this challenges. Future perspectives are discussed, exploring the relationship of clinical neuroscience and social psychiatry.
Subject(s)
Community Psychiatry/trends , Mental Disorders/therapy , National Health Programs/trends , Population Dynamics , Social Change , Social Problems/trends , Adult , Aged , Community Psychiatry/economics , Cost-Benefit Analysis , Cross-Sectional Studies , Forecasting , Germany , Humans , Mental Disorders/economics , Mental Disorders/epidemiology , Middle Aged , National Health Programs/economics , Neurosciences/trends , Research/trends , Social Problems/economics , Social Problems/psychologySubject(s)
Hospitals, Psychiatric/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Privatization/legislation & jurisprudence , Ambulatory Care/legislation & jurisprudence , Community Psychiatry/economics , Community Psychiatry/legislation & jurisprudence , Cost-Benefit Analysis/economics , Cost-Benefit Analysis/legislation & jurisprudence , Day Care, Medical/economics , Day Care, Medical/legislation & jurisprudence , Delivery of Health Care/economics , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care, Integrated/economics , Delivery of Health Care, Integrated/legislation & jurisprudence , Germany , Hospitals, Psychiatric/economics , Humans , Mental Disorders/economics , Mental Disorders/rehabilitation , National Health Programs/economics , Patient Care Team/economics , Patient Care Team/legislation & jurisprudence , Privatization/economicsABSTRACT
In the late 1990s, the government of Ontario undertook a province-wide implementation of Assertive Community Treatment (ACT). Capacity grew to 59 teams within 6 years. This paper describes the implementation process, focusing on three phases--start-up, or the enabling phase; feedback, or the reinforcement phase; and response, or the corrective action phase. Key implementation supports include an active oversight committee with representation from both the ministry and the field and the availability of the planning data on ACT performance. Three areas of underperformance were identified: lower than expected team caseloads, drift from the target client group, and significant under-staffing in the teams. Likely causes were suggested, and corrective actions developed, which centered on clarifying the ACT standards, especially related to intake criteria, rate of intake and staffing, increasing team funding, and establishing expectations for reporting and accountability. While these corrective responses are promising, implementation of infrastructure and mechanisms for providing systematic practice feedback is still underdeveloped.
Subject(s)
Community Psychiatry/organization & administration , Diffusion of Innovation , Community Mental Health Centers , Community Psychiatry/economics , Humans , Mental Disorders/rehabilitation , Mental Disorders/therapy , Ontario , Severity of Illness IndexSubject(s)
Community Mental Health Centers/economics , Community Psychiatry/economics , Health Care Rationing/economics , National Health Programs/economics , Quality Assurance, Health Care/economics , Community Mental Health Centers/organization & administration , Community Psychiatry/organization & administration , Cost Control/trends , Germany , Humans , Organizational Objectives , Quality Assurance, Health Care/organization & administrationSubject(s)
Ambulatory Care/organization & administration , Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Community Psychiatry/organization & administration , Ambulatory Care/methods , Ambulatory Care/trends , Community Mental Health Centers/economics , Community Mental Health Centers/statistics & numerical data , Community Mental Health Centers/trends , Community Mental Health Services/economics , Community Mental Health Services/statistics & numerical data , Community Mental Health Services/trends , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Humans , Hungary , Organizational Innovation , Program Development , Program Evaluation , WorkforceSubject(s)
Child Health Services/organization & administration , Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Community Psychiatry/organization & administration , Foundations , Adolescent , Child , Child Health Services/economics , Child Health Services/trends , Community Mental Health Centers/economics , Community Mental Health Centers/trends , Community Mental Health Services/economics , Community Mental Health Services/trends , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Humans , Hungary , Mental Disorders/rehabilitation , Mental Health , Organizational Innovation , Program Development , Program Evaluation , WorkforceSubject(s)
Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Community Psychiatry/organization & administration , Community Mental Health Centers/economics , Community Mental Health Centers/trends , Community Mental Health Services/economics , Community Mental Health Services/trends , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Humans , Hungary , Interdisciplinary Communication , Organizational Innovation , Program Development , Program EvaluationSubject(s)
Ambulatory Care/organization & administration , Behavior, Addictive/therapy , Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Community Psychiatry/organization & administration , Foundations , Substance-Related Disorders/therapy , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/trends , Amphetamine-Related Disorders/therapy , Behavior, Addictive/prevention & control , Behavior, Addictive/rehabilitation , Communication , Community Mental Health Centers/economics , Community Mental Health Centers/trends , Community Mental Health Services/economics , Community Mental Health Services/trends , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Cooperative Behavior , Counseling , Harm Reduction , Humans , Hungary , Opioid-Related Disorders/therapy , Primary Prevention/organization & administration , Substance-Related Disorders/prevention & control , Substance-Related Disorders/rehabilitationSubject(s)
Ambulatory Care/organization & administration , Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Community Psychiatry/organization & administration , Foundations , Substance-Related Disorders/therapy , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/trends , Behavior, Addictive/therapy , Community Mental Health Centers/economics , Community Mental Health Centers/trends , Community Mental Health Services/economics , Community Mental Health Services/trends , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Humans , Hungary , Program Development , Program Evaluation , Substance-Related Disorders/prevention & control , Substance-Related Disorders/rehabilitationSubject(s)
Community Psychiatry/organization & administration , Medical Records/standards , Persons with Mental Disabilities , Surveys and Questionnaires/standards , Assertiveness , Cognitive Behavioral Therapy , Community Psychiatry/economics , Community Psychiatry/methods , Community Psychiatry/trends , Crisis Intervention , Humans , Hungary , Persons with Mental Disabilities/psychology , Persons with Mental Disabilities/rehabilitation , Risk Assessment , Risk Factors , Stress, PsychologicalABSTRACT
BACKGROUND: People with schizophrenia comprise the majority of patients with severe mental illness recruited to recent mental health service studies of new teams (e.g. assertive outreach, crisis resolution). Reduction in hospitalisation has been the most consistent outcome measure in these studies, but results are inconsistent. AIMS: To understand inconsistency of results from studies using hospitalisation as an outcome measure. METHOD: The advantages and disadvantages of hospitalisation are explored, including the ways in which it is recorded. Regional variation in outcomes and the impact of control services are reviewed. RESULTS: Hospitalisation has face validity as an outcome but translates poorly between differing healthcare contexts. These variations can be exploited positively to distinguish potentially effective ingredients in community care (outreach, combined health and social care, team structure) from redundant components. CONCLUSIONS: Hospitalisation is a good proxy outcome measure in schizophrenia care in randomised controlled trials, but the dangers of extrapolating to new contexts require care.
Subject(s)
Community Psychiatry/economics , Hospitalization/economics , Psychotic Disorders/therapy , Schizophrenia/therapy , Community Psychiatry/methods , Community Psychiatry/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Outcome Assessment, Health Care , Psychiatric Status Rating Scales/statistics & numerical data , Psychotic Disorders/economics , Quality of Life/psychology , Schizophrenia/economics , Treatment OutcomeSubject(s)
Community Psychiatry/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Persons with Mental Disabilities/rehabilitation , Schizophrenia/rehabilitation , Schizophrenic Psychology , Combined Modality Therapy/economics , Community Psychiatry/economics , Cost Control/economics , Germany , Humans , National Health Programs/economics , Persons with Mental Disabilities/psychology , Prejudice , Social Support , Social Work, Psychiatric/economicsABSTRACT
There will be an enormous change for general as well as social psychiatry in the next decade. With regard to schizophrenia it is apparent that only innovative research strategies and practical care together may be able to improve the clinical outcome of these disabled persons in the long term. Definitely, a modern social psychiatry does need a better understanding of different aspects of schizophrenia, which includes comprehensive knowledge about its ethiological genetic- and cognitive-based hypotheses as well as awareness of modern drug strategies and effective rehabilitation programs. Alike health economic aspects will reform social psychiatry as its own concepts have to prove their efficacy not only from a therapeutical view but also with respect to its short-, middle- and long-term cost effectiveness.
Subject(s)
Community Psychiatry/trends , Schizophrenia/rehabilitation , Antipsychotic Agents/economics , Antipsychotic Agents/therapeutic use , Combined Modality Therapy/economics , Combined Modality Therapy/trends , Community Psychiatry/economics , Cost-Benefit Analysis/trends , Forecasting , Germany , Humans , Schizophrenia/economics , Schizophrenia/etiologyABSTRACT
O objetivo deste trabalho é a reconstituição histórica do período imediatamente anterior àquele que se denominou Movimento de Reforma Psiquiátrica no Brasil. Os marcos desse período são a criação do INPS, em 1967, e o momento em que ganhou destaque o Movimento dos Trabalhadores em Saúde Mental, em 1978. Discutem-se as contradições da política oficial de saúde mental no país, enfocando critérios técnicos influenciados pelo modelo preventivista norte-americano, e a prática de financiamento e fortalecimento das instituições psiquiátricas privadas, em detrimento das ações comunitárias. Embora a maioria dos documentos oficiais da década de 1970 apresente uma proposta claramente voltada para as ações comunitárias, o que se observou foi a cristalização do modelo de compra de leitos psiquiátricos em hospitais privados pelo poder público.
Subject(s)
History, 20th Century , Community Psychiatry , Psychiatry , Public Health , Brazil , Community Psychiatry/economics , Community Psychiatry/history , Community Psychiatry/legislation & jurisprudence , Community Psychiatry/methods , Community Psychiatry/trends , Health Care Reform/economics , Health Care Reform/history , Health Care Reform/legislation & jurisprudence , Health Care Reform/methods , Health Care Reform/trends , Health Policy/economics , Health Policy/history , Health Policy/legislation & jurisprudence , Hospitals, Psychiatric/history , Psychiatry/economics , Psychiatry/history , Psychiatry/legislation & jurisprudence , Psychiatry/methods , Psychiatry/trends , Public Health/history , Public Health/legislation & jurisprudence , Public Health/methodsABSTRACT
The article provides a historical reconstruction of the period leading up to what has become known as Brazil's Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazil's official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.