The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.
INTRODUCTION In New Zealand, as in other OECD countries, there is a high and growing prevalence of mental health problems, particularly anxiety and depression. These conditions are associated with a range of physical illnesses, and as a result this population have high and often complex needs for healthcare services, particularly through primary care. AIM To use data from the New Zealand Health Survey (NZHS) to examine the associations between internalising disorders (including anxiety, depression and bipolar disorder) and measures related to the utilisation of primary healthcare services. METHODS The study was based on responses from 13,719 adults who took part in the 2015-16 NZHS. Logistic regression analyses adjusted for sociodemographic variables were undertaken to examine the effect of having an internalising disorder on each measure related to primary healthcare utilisation. The strength of associations was indicated by odds ratios (ORs). RESULTS Adults with an internalising disorder were more likely to utilise primary health services (OR = 1.43-2.56, P < 0.001) compared to adults without an internalising disorder. However, they were more likely to have unmet needs due to cost or transport (OR = 2.45-3.38, P < 0.001), unfilled prescriptions due to cost (OR = 3.03, P < 0.001) and less likely to report positive experiences with general practitioners (OR = 0.67-0.79, P < 0.01). DISCUSSION Adults with internalising disorders require a higher level of support from primary healthcare, yet experience more barriers to accessing these services, and report less positive experiences with general practitioners. The NZHS may be a useful source of routinely collected data for understanding, monitoring and improving primary health service utilisation among people with internalising disorders.
Purpose Mental health literacy programmes can help reduce stigma towards people who experience mental health challenges. Co-facilitated mental health literacy programmes, delivered by a person with lived experience of mental health challenges in partnership with a person with clinical experience in mental health services, may further reduce stigma. This qualitative study aims to explore participants’ satisfaction with a co-facilitated mental health literacy programme and facilitator characteristics influencing satisfaction. Design/methodology/approach The authors used deidentified post-workshop evaluation data from 762 community mental health literacy programme participants (86% response rate). Thematic analysis of qualitative data used a general inductive approach. Findings Findings indicate high satisfaction with the co-facilitation model used to deliver a mental health literacy programme. Three key themes related to co-facilitation satisfaction: how participants perceived the co-facilitation model overall; the impact of having two facilitators that offered different knowledge and perspectives about mental health challenges; and the impact of personal stories shared. The personal stories shared by facilitators were perceived as bringing the workshop content to life and providing insights into people’s experiences and well-being journey. Key themes influencing co-facilitation satisfaction related to facilitator knowledge, skills, values and attitudes. Practical implications Findings indicate the positive impact of incorporating people’s lived experience into the design and delivery of mental health literacy programmes. Findings highlight key facilitator characteristics and support needs when recruiting facilitators to deliver programmes. This includes good facilitation skills alongside personal experiences. Originality/value To the best of the authors’ knowledge, this is the first large study examining satisfaction with a co-facilitated mental health literacy programme for the general public.
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