Personal health budget in patients with first episode psychosis: A new rehabilitation model based on a community care system in Italy

Abstract

Aim Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first‐episode psychosis (FEP) across a 2‐year follow‐up period. Methods Participants (n = 104; 18–50 years) were recruited within the ‘Parma‐Early Psychosis’ program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed‐design analysis of variance (ANOVA) and Kaplan‐Maier survival analysis (as drop‐out measure) were performed. Results A significant effect of time on all BPRS, HoNOS and GAF scores along the follow‐up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed‐design ANOVA results showed a significant ‘time x group’ interaction effects on BPRS ‘Disorganization’, HoNOS ‘Psychiatric Symptoms’ and GAF scores in FEP participants with PHB. Kaplan‐Meyer survival analysis showed a longer survival mean for FEP patients with PHB. Conclusions Our results support the applicability of a PHB model within an ‘Early Intervention in Psychosis’ program in public community mental health services.

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

“…A total of 11,541 people participated in the 29 selected studies (range = 9; ( 38 ) – 6,908; ( 26 ); in studies conducted by the same authors, the participants may overlap). The mean ages of samples ranged from 26.08 ( 33 , 34 ) to 58.7 ( 30 ) years. The proportion of females ranged from 26% ( 33 ) to 87% ( 39 ).…”

“…The mean ages of samples ranged from 26.08 ( 33 , 34 ) to 58.7 ( 30 ) years. The proportion of females ranged from 26% ( 33 ) to 87% ( 39 ). Studies evaluated PB ( n = 9), personal health budgets ( n = 4), health budget ( n = 1), individual budget ( n = 1), self-directed care ( n = 3), individual health budget ( n = 2), patient-centered medical home (PCMH) ( n = 1), person-centered planning ( n = 1), Mental Health Access to Recovery or MHATR ( n = 1), personalization of the care ( n = 1), Cash and Counseling-based self-directed services program ( n = 1), behavioral health home intervention arm ( n = 1), shared management ( n = 1), person-centered and self-directed (SPS) service ( n = 1), and supported housing ( n = 1), as defined by the authors, to define PB, which exist different acronyms (e.g., PB, PHB, and HB).…”

“…Most participants from Larsen et al ( 52 ) and Peterson et al ( 40 ) studies identified positive outcomes (e.g., mental health and wellbeing, psychological benefits, social participation and relationships, and confidence) from using personal-centered services. Leuci et al ( 33 ) showed that patients enrolled in the PHB intervention, at the end of the 2-year follow-up, reported higher improvements in negative symptoms, disorganization, and activation dimension (including manic features and hyperactivity) and in HoNOS “Impairment” subscale. In addition, in the period between T1 and T2, patients enrolled in the PHB showed a further significant decrease in positive symptoms, activation and affective dimension (including depressive characteristics, suicidality, and anxiety), improvements in functioning, and in HoNOS “Impairment,” “Psychiatric Symptoms,” and “Behavioural Problems” subscales.…”

Association between psychosocial interventions and aberrant salience in adolescents with early psychosis: A follow‐up study

“…For case management , every subject/family has a dedicated case manager who coordinates all the planned interventions, in particular those aimed to a recovery‐oriented early rehabilitation. Specifically, a tailored and patient‐centered care pathway has to be designed in order to promote the best possible social and job inclusion, also using models of vocational rehabilitation and supported employment (Leuci, Pelizza, Landi et al ., 2022). In the first year of intervention, at least 12 sessions per patient (each lasting 60 min) are provided, according to social and occupational functioning.…”

Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2‐year follow‐up of the ‘Parma Early Psychosis’ programme

“…We clustered these items in accordance with the five‐factor model emerged in a comprehensive meta‐analysis on the BPRS structure (Dazzi et al, 2016), including ‘Disorganization’, ‘Positive’, ‘Negative’, ‘Affect’ and ‘Activation’ dimensions. In the present research, we adopted the authorized Italian translation of the BPRS (Version 4.0) (Morosini & Casacchia, 1995), which showed good psychometric properties in Italian clinical populations (Roncone et al, 1999), including young patients with early psychosis (Leuci et al, 2021).…”