Components of a modern mental health service: a pragmatic balance of community and hospital care

Thornicroft, Graham; Tansella, Michele

doi:10.1192/bjp.185.4.283

Cited by 355 publications

(261 citation statements)

References 79 publications

(72 reference statements)

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“…As such, the findings of the present study align with the recommendations made recently by the National Mental Health Commission in its Report of the National Review of Mental Health Programs and Services. 1 According to several international models, [21][22][23] specialised adult mental health services should include the following components: specialised out-patient/ambulatory clinics; assertive community treatment (ACT) teams; alternatives to acute in-patient care; alternative types of long-stay community residential care; and specialised forms of work and occupation. Community-based care and living arrangements are only sustainable if located within a broader system of care that provides short-term expert acute care to manage crisis.…”

Section: Discussionmentioning

confidence: 99%

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

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Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

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Section: Discussionmentioning

confidence: 99%

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

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“…There is international consensus that care for people with schizophrenia should largely be delivered in community settings for the best outcomes[4]. While in high resource countries, community care is the norm, in low income countries, the availability of community services is the exception[5]. Thus, for the majority of persons with schizophrenia and their caregivers in low income countries, including in India, there is little access to any care [6].…”

Section: Introductionmentioning

confidence: 99%

Collaborative community based care for people and their families living with schizophrenia in India: protocol for a randomised controlled trial

Chatterjee

Leese

Koschorke

et al. 2011

Trials

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BackgroundThere is a large treatment gap with few community services for people with schizophrenia in low income countries largely due to the shortage of specialist mental healthcare human resources. Community based rehabilitation (CBR), involving lay health workers, has been shown to be feasible, acceptable and more effective than routine care for people with schizophrenia in observational studies. The aim of this study is to evaluate whether a lay health worker led, Collaborative Community Based Care (CCBC) intervention, combined with usual Facility Based Care (FBC), is superior to FBC alone in improving outcomes for people with schizophrenia and their caregivers in India.Methods/DesignThis trial is a multi-site, parallel group randomised controlled trial design in India.The trial will be conducted concurrently at three sites in India where persons with schizophrenia will be screened for eligibility and recruited after providing informed consent. Trial participants will be randomly allocated in a 2:1 ratio to the CCBC+FBC and FBC arms respectively using an allocation sequence pre-prepared through the use of permuted blocks, stratified within site. The structured CCBC intervention will be delivered by trained lay community health workers (CHWs) working together with the treating Psychiatrist. We aim to recruit 282 persons with schizophrenia. The primary outcomes are reduction in severity of symptoms of schizophrenia and disability at 12 months. The study will be conducted according to good ethical practice, data analysis and reporting guidelines.DiscussionIf the additional CCBC intervention delivered by front line CHWs is demonstrated to be effective and cost-effective in comparison to usually available care, this intervention can be scaled up to expand coverage and improve outcomes for persons with schizophrenia and their caregivers in low income countries.Trial registrationThe trial is registered with the International Society for the Registration of Clinical Trials and the allocated unique ID number is ISRCTN 56877013.

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“…Research has indicated that many mental healthcare professionals have difficulty maintaining a balance between work and life [10,11]. The purpose of the intervention was to create opportunities for an organization to address work-life balance issues.…”

Section: Purposementioning

confidence: 99%

Work-Life Balance Issues among Mental Health Professionals Capstone

Tejera¹

2014

MOJPH

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Components of a modern mental health service: a pragmatic balance of community and hospital care

Abstract: Both community and hospital services are necessary in all areas regardless of their level of resources, according to the additive and sequential stepped care model described here.

Cited by 355 publications

References 79 publications

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Collaborative community based care for people and their families living with schizophrenia in India: protocol for a randomised controlled trial

Work-Life Balance Issues among Mental Health Professionals Capstone

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