A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes

Abstract

BackgroundThis survey followed a cohort of patients with chronic psychosis recruited from five catchment areas (DSMs) of the Sardinian community mental health services. The objective was to examine whether the amount of resources in the different sites may be a determinant of the outcomes.MethodsNaturalistic follow-up study on 309 consecutive users with diagnosis of schizophrenic disorder, schizoaffective disorder, bipolar affective disorder with psychotic symptoms (DSM-IV TR) of five Sardinian community mental health services. Mental state and clinical symptoms along with functioning were assessed using semi-structured clinical interviews (ANTAS), Clinical Global Impression Severity Scale (CGI-S), Global Assessment of Functioning Scale (GAF) and Health of the Nation Outcome Scales (HONOS). Assessments were conducted at the beginning of the study and after one year.ResultsThe proportion of professionals working in all DSMs participating in the study was found lower than the national Italian standard (0.7 vs 1.0 per 1,500 inhabitants). Follow-up revealed significant differences between DSMs in the improvement of the Honos scores (F = 5.932, p = 0.000). These differences correlate with the improvement of resources in terms of number of professionals during, and one year prior, to the trial.ConclusionsThe study shows that mental health services provided in the public sector in Sardinia are still very resource-poor, at least in terms of human resources. Our findings suggest that mental health service resources influence outcomes as regards the social functioning of users. We urge policy makers to take these observations into account when planning future services.

Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder

“…Our data do not appear to confirm the association between Tako-tsubo and anxious syndromes previously reported in literature [10, 12, 23]. …”

“…The divergence in the association with Tako-tsubo e Anxiety Disorders shown in literature data may be because this is the first study to have used diagnoses according to international criteria based on semi-structured clinical interviews conducted by the clinical staff [17, 23]. In our survey, we separately analyzed the patients with anxiety disorders from those with comorbid anxiety-depression in order to understand if anxiety alone may be a determinant or if comorbidity with mood disorder could be a confounding factor.…”

Sailing for Rehabilitation of Patients with Severe Mental Disorders: Results of a Cross Over Randomized Controlled Trial

“…Rehabilitation can improve the social outcome of patients, well beyond the effectiveness of the prescribed therapeutic interventions [5, 6]. Sports activities have often been used as a rehabilitation tool for patients with severe psychiatric disorders [7, 8].…”

Organizational Wellbeing among Workers in Mental Health Services: A Pilot Study

“…The study was promoted under the project “QAL.SAR.PSY.” [ 8 , 10 ], as a part related to the quality of the working life of workers in Sardinian mental health services specifically.…”

“…The centrality of users and the humanization of care involve many abilieties of the workers, such as listening, continuity in caring, timeliness, good skills in communication, problem solving and crisis management. Furthermore, in Italy as well as in other European countries with a National Public Health System, mental health services are facing severe financial shortages and consequent shortfalls in the number of sector-employed professionals [ 8 - 11 ]. Even more, the quality of the performances depends also on the professional and personal qualities of workers, who often offset structural deficiencies and procedural difficulties with their efforts and highly skilled job.…”