EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

Gäebel, Wolfgang; Kerst, Ariane; Janssen, Birgit; Becker, Thomas; Musalek, M.; Rössler, Wulf; Ruggeri, Mirella; Thornicroft, Graham; Zielasek, Jürgen; Stricker, Johannes

doi:10.1192/j.eurpsy.2020.75

Cited by 12 publications

(15 citation statements)

References 37 publications

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“…While intervention in primary psychosis remains challenging [ 34 , 35 ], filling the therapeutic gap for FEP patients offering optimized, community-based, multi-disciplinary approaches should be a priority. Quality in Mental Health Services is pivotal for the effectiveness and efficiency of mental healthcare systems [ 36 ]. While scarce financial support and lack of government recognition of EIS importance are reported as key barriers for implementation of EIS services [ 37 ], a recent government legislation setting the legal framework for the establishment of EIS in Greece (Official Government Gazette of the Hellenic Republic, A 256—23.12.2020) within the National Health System has been an important, but still a first, initial step.…”

Section: Discussionmentioning

confidence: 99%

Don’t blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model

et al. 2022

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Background Early Intervention Services (EIS) aim to reduce relapse rates and achieve better treatment and functional outcomes for first episode psychosis (FEP) patients. Existing models of services in Greece are still treatment as usual (TAU), however a reform of mental health services is underway and initial steps have been taken to shift standard care towards EIS. The purpose of the study is to address therapeutic gaps by exploring service engagement and relapse rates in the current standard care model for psychosis. Methods We examined follow-up and relapse rates one year after initial treatment contact in the first longitudinal FEP study conducted in Greece. 225 patients were enrolled between 2015–2020. Sociodemographic, clinical and functional characteristics were assessed in association with follow-up and relapse rates. Results Within a TAU follow-up setting, one year attrition rates were high. Only 87 patients (38,7%) retained contact with services after one year and within this time frame, 19 of them (21,8%) experienced a severe relapse requiring rehospitalization. Demographic, clinical and functional contributors failed to predict service engagement and relapse rates, with the exception of treatment adherence. Conclusion Both follow-up and one-year rehospitalization rates in our FEP sample, highlight the need for the implementation of early intervention services, that will aim at engagement maximization and relapse prevention. These indexes also provide a benchmark against which future early intervention services for psychosis in Greece will have to demonstrate superior efficacy.

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Section: Discussionmentioning

confidence: 99%

Don’t blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model

et al. 2022

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“…In addition, two papers with a qualitative design emphasize adding an occupational therapist to a multidisciplinary team (44,50). Finally, seven papers show the value of peer support to multidisciplinary teams; of which these seven papers, there are three reviews (29)(30)(31), three qualitative papers (47,48,51), and one expert paper (53).…”

Section: Multidisciplinary Teamsmentioning

confidence: 99%

Current insights of community mental healthcare for people with severe mental illness: A scoping review

et al. 2023

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BackgroundFor the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare.MethodsWe conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals.ResultsThe search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships.ConclusionWe found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.

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“…Several important determinants of the effectiveness and efficiency of mental health care systems, including the mix of service types, the distribution of service providers relative to need, and the level of co-ordination across services [24][25][26], were not modelled explicitly in the analyses presented here. Additionally, our analyses effectively disregard potentially significant heterogeneity in individual-level factors affecting service engagement (i.e., help-seeking), disease progression, and recovery rates (principal diagnosis, comorbidities, age, gender, etc.)…”

Section: Limitationsmentioning

confidence: 99%

Bi-stability and critical transitions in mental health care systems: a model-based analysis

Skinner

Occhipinti

Prodan

et al. 2023

Int J Ment Health Syst

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Background Delayed initiation and early discontinuation of treatment due to limited availability and accessibility of services may often result in people with mild or moderate mental disorders developing more severe disorders, leading to an increase in demand for specialised care that would be expected to further restrict service availability and accessibility (due to increased waiting times, higher out-of-pocket costs, etc.). Methods We developed a simple system dynamics model of the interaction of specialised services capacity and disease progression to examine the impact of service availability and accessibility on the effectiveness and efficiency of mental health care systems. Results Model analysis indicates that, under certain conditions, increasing services capacity can precipitate an abrupt, step-like transition from a state of persistently high unmet need for specialised services to an alternative, stable state in which people presenting for care receive immediate and effective treatment. This qualitative shift in services system functioning results from a ‘virtuous cycle’ in which increasing treatment-dependent recovery among patients with mild to moderate disorders reduces the number of severely ill patients requiring intensive and/or prolonged treatment, effectively ‘releasing’ services capacity that can be used to further reduce the disease progression rate. We present an empirical case study of tertiary-level child and adolescent mental health services in the Australian state of South Australia demonstrating that the conditions under which such critical transitions can occur apply in real-world services systems. Conclusions Policy and planning decisions aimed at increasing specialised services capacity have the potential to dramatically increase the effectiveness and efficiency of mental health care systems, promoting long-term sustainability and resilience in the face of future threats to population mental health (e.g., economic crises, natural disasters, global pandemics).

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EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

Cited by 12 publications

References 37 publications

Don’t blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model

Don’t blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model

Current insights of community mental healthcare for people with severe mental illness: A scoping review

Bi-stability and critical transitions in mental health care systems: a model-based analysis

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