Identifying Local and Centralized Mental Health Services—The Development of a New Categorizing Variable

Abstract

The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.

Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

“…Of the articles that applied ESMS/DESDE system, 48.4% carried out a cross-sectoral evaluation, in some cases focused on specific target groups. The health sector was the focus of 18.7% of the papers; 26.7% related to specific health care: one paper described primary care services for patients with depression [51], three papers evaluated mental health and substance abuse services [33, 88, 90], one paper evaluated transition services from child and adolescent to adult mental health care [36] and others assessed other specific mental health services. One article focused on the evaluation of vocational services for people with schizophrenia [70] and nine papers described services used for specific target population like people with schizophrenia [30, 52, 53, 57, 61, 62, 70, 34] and intellectual disabilities [78].…”

“…This approach was advanced 20 years ago by the EPCAT group when the assessment of services provided by ESMS was accompanied by the standard analysis of the social and demographic context using ESDS [19], and by the description of the main modalities of care using ICMHC [18]. Whilst WHO-AIMS [38] and the Mental Health Country Profile (MHCP) [100] have been used for describing national mental health systems worldwide, ESMS/DESDE is the only system that provides local, bottom-up information that can be used across different sectors (health, social, education, employment, housing and justice) [99] and for coding services for different target groups such as mental disorders [89, 51] intellectual disabilities [78], substance abuse [33, 88, 90], general disabilities [20], aging and long term care [21, 22]. The usability of ESMS/DESDE for the analysis of local change and improvement has been tested in Catalonia (Spain) where the evolution of the mental health care system was analysed before and after the implementation of the 2006 regional mental health plan (2002–2010) [81].…”

Everyday work, working culture and patient care. A qualitative study on professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric center.

“…Whether mental health care is provided mainly at the primary or secondary care level varies a lot in Europe [31]. Researchers have claimed that collaboration between the primary and secondary mental health services is needed to provide care across systems [32], and that a shift in resource balance between the care levels is needed [33]. Collaboration between primary and secondary health services is also emphasized and advised in treatment guidelines for common mental health treatment [30,34], and several models have been suggested for closer integration and collaboration [35].…”

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

“…Whether mental health care is provided mainly at the primary or secondary care level varies a lot in Europe [40]. Researchers have claimed that collaboration between the primary and secondary mental health services is needed to provide care across systems [41], and that a shift in resource balance between the care levels is needed [42]. Collaboration between primary and secondary health services is also emphasized and advised in treatment guidelines for common mental health treatment [37,43], and several models have been suggested for closer integration and collaboration [44].…”