Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project

Abstract

BackgroundJapan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP.MethodThis longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time.ResultsThe rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to “prevent exacerbation of somatic symptoms” and “care for families”.ConclusionThese results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.

How Japanese public health nurses manage neighbors’ complaints toward mentally ill persons with problematic behaviors?

“…Our findings support a previous study which showed that PHNs utilized multiple sources of data for identifying an individual's health condition 18) . Additionally, in Japan, many families live with MIPs and play an important role in caring for them 24,13) . Previous studies showed that the level of caregiver burden is related to the severity of illness of the MIPs 25) .…”

“…Assessing the mental health conditions of MIPs using early warning signs was a key factor in reducing the readmission rate, as well as medicald costs 12) . However, identifying the relapse of patients is difficult because it depends greatly on the level of recognition of the patients and their families living in the community 13) . Furthermore, relapse causes problematic behaviors in MIPs.…”

A pragmatic evaluation of a nationwide mental health outreach service in Japan raises more questions than answers

“…Kayama and colleagues evaluated the effectiveness of the nationwide Japanese Outreach Model Project (JOMP), established in 2011 by the Japanese Ministry of Health to provide multidisciplinary outreach services for eligible patients to prevent them from repeated hospitalisations 2. Patients, who do not or will not use regular Japanese outpatient care funded by public insurance, but are at high-risk for hospitalisations are the target population of JOMP.…”

Prioritizing Patient Assessment Data (PAD) Using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©

“…Kayama et al [3] explained that, as a reaching out approach, in Japan, it is the intervention in family and the prevention against worsening physical symptom that caused the reduction of re-hospitalization. According to a study by Nakanishi et al [11], nurses' involvement in patients in making the plan of discharge since the acute care period caused the decline of the rate of re-hospitalization.…”

“…Long-term hospitalization is a problem in psychiatric hospitals in Japan [1]. Today, the Japanese government is promoting outreach services [2], and patient transitions from hospital to community as social rehabilitation strategy [3]. This situation is essential to prevent re-admissions and early discharge of patients, and to provide appropriate treatments and interdisciplinary care to patients with psychiatric disorders.…”