Rates of seclusion vary across New Zealand's publicly funded district health board (DHB) adult mental health inpatient services as indicated by national data. Anecdotally, this variation has been attributed to a range of factors directly relating to the people admitted to acute inpatient services. This study examined the extent to which variation in seclusion rates could be explained by the sociodemographic and clinical differences between populations admitted into adult mental health inpatient services. Retrospective data were obtained from the Programme for the Integration of Mental Health Data (PRIMHD). A logistic regression model was fitted to these data, with seclusion (yes/no) as the dependent variable and DHB groups as the independent variable. The DHBs were classified into four groups based on their seclusion rates. The model adjusted for ethnicity, age, number of bed nights, total Health of the Nation Outcome Scales (HoNOS) scores, and compulsory treatment status. Odds ratios remained virtually unchanged after adjustment for sociodemographic and clinical factors. People admitted to DHB Group 4 (highest secluding DHBs) were 11 times more likely to be secluded than people in Group 1 (lowest secluding DHBs), adjusted OR = 11.1, 95% CI [7.5,16.4], P < 0.001. Results indicate DHB variation in seclusion rates cannot be attributed to the sociodemographic and clinical factors of people admitted into DHB adult mental health inpatient services. Instead, this variation may be explained by differences in service delivery models and practice approaches. A model of system improvements aimed at reducing seclusion is discussed.
This paper provides a detailed description and critique of the development of routine outcome measurement (ROM) within New Zealand's mental health and addiction services. The paper will include a brief description of the New Zealand setting and the events that led to routine outcome measures, demographic and diagnostic characteristics of the population in New Zealand, characteristics of the New Zealand mental health and addictions services, a description of the outcome measures and rationale for their selection, the information collection protocol for the outcome measures, outcome data completion rates and aggregated outcome reporting uses, barriers and facilitators to the adoption of routine outcome measures in New Zealand, and current status and next steps.
BackgroundIt has been proposed that gains would be made in the validity of the psychiatric classification system if many of the present 'neurotic' or personality disorders were subsumed into two over-arching groups, externalising and emotional disorders. If diagnostic sub-categories from the first digit coding structures within ICD-10 do, in fact, share clinical phenomenology that align with the major externalising/emotional distinction, this further supports the proposal and contributes to face validity. The aim of the study was to examine the distribution of particular psychopathology within and between two proposed over-arching groupings - externalising and emotional disorders - in a clinical sample.MethodThe distributions of HoNOS derived information in relation to the proposed clusters of emotional disorders and extrinsic disorders are examined.ResultsStatistically significant differences in profiles between the emotional and the externalising groupings are consistent with the proposed classification development. The HoNOS (Health of Nation Outcome Scale) measures of self harm, depression, aggression, occupational/leisure problems and drug and alcohol consumption are the five most significant discriminators between the two groups.DiscussionThe details of the profile differences within the two over arching groups suggest that further examination is required. Useful work could include examination in credibly large and unselected patient populations of the factor structure demonstrated in non patient samples. Prospective comprehensive trials of the contributions the proposed classification could make to clinical decision making would also help illuminate this area.
Over the last two decades New Zealand has undergone fundamental economic restructuring, and phases of slow and rapid growth, which have resulted in some dramatic changes in the regional economies. This paper focuses on changes in regional employment outcomes in terms of the impact of national trends on regions, sectoral composition within regions, structural change and local conditions. These changes are quantified by means of classic shift-share analysis. Regions are clustered based on the direction and relative importance of national and region-specific effects. The clustering highlights the chasm that has developed in New Zealand between metropolitan and other services-oriented regions vis-a-vis rural and peripheral regions.
This article draws on the theoretical construct of micro-level intergenerational solidarity developed by Bengtson and others to establish the factors influencing the associative and structural dimensions of solidarity for the dyad of mid-life parent and young adult child. This dyadic relationship may be subject to the constraining effects of responsibilities associated with mid-life, and the increasingly complex process associated with youth transition to adulthood, suggesting the potential for weakened intergenerational bonds of co-residence and communication. Empirical analysis, using multivariate logistic regression techniques draws on data from a 1997 New Zealand sample survey examining intergenerational relations between individuals aged 40-54 and their children and ageing parents. Results indicate that marital status, gender, religion and ethnicity exert a particular influence on both dimensions of solidarity, and that the potentially constraining factors of household income, employment, family size and the presence of ageing parents do not appear to weaken them unduly. Results do suggest that both dimensions of solidarity are weakened by parental divorce and separation, but remain the strongest when children share a biological link with parents.
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