Tertiary Mental Health Services: I. Key Concepts

Abstract

There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services. Increasingly, organized systems have been developed to ensure that individuals meet criteria for tertiary care and receive the most appropriate level of care. Most importantly, the delivery of tertiary care must not be tied to particular settings or time frames, and level of care must be delinked from model or location of care in order to create flexible, efficient, effective mental health services.

Assertive Community Treatment in the Netherlands: Outcome and Model Fidelity

“…Compared with other countries, the bed rate in the Netherlands remains among the highest in the world. 33 Unlike other countries, 22,[34][35][36] deinstitutionalization has not been a topic of high priority for the Dutch government. The Netherlands can be characterized as a caring society, where marginalization is not accepted.…”

Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

“…Tertiary care programs for TRS should include individually tailored psychosocial rehabilitation, as well as personalised and evidence-based medication management, to achieve flexible and effective care. 9 Clozapine is the only recommended antipsychotic treatment for TRS and is the most effective agent for reducing symptoms, 10 hospital use, 11 suicide rates, 12,13 aggressive behaviour, 14 violent crime 15 and substance misuse. 16 However, the management of clozapine therapy for patients with severe and chronic behavioural problems requires carefully developed strategies and close monitoring of adverse effects, which can be challenging in a primary or secondary care setting.…”

Development and psychometric evaluation of the Transdiagnostic Decision Tool: matched care for patients with a mental disorder in need of highly specialised care

“…tertiary mental healthcare) is the care provided by highly trained professionals to individuals with mental health problems that are complex and refractory to interventions provided in specialised (for example secondary) mental healthcare settings such as community mental health centres and general hospitals. 22,23 Given the level of necessary staff expertise, assessment and resources, highly specialised mental healthcare is often, but not per definition, provided in mental healthcare centres affiliated with academic medical settings. 22 In order to enhance the early identification and adequate management of patients with mental health problems in need of highly specialised care, the following four diagnosis-specific decision support algorithms were developed: the Decision Tool Personality Disorders, 19 the Decision Tool Eating Disorders, 18 the Decision Tool Unipolar Depression 20 and the Decision Tool Anxiety Disorders.…”

“…22,23 Given the level of necessary staff expertise, assessment and resources, highly specialised mental healthcare is often, but not per definition, provided in mental healthcare centres affiliated with academic medical settings. 22 In order to enhance the early identification and adequate management of patients with mental health problems in need of highly specialised care, the following four diagnosis-specific decision support algorithms were developed: the Decision Tool Personality Disorders, 19 the Decision Tool Eating Disorders, 18 the Decision Tool Unipolar Depression 20 and the Decision Tool Anxiety Disorders. 21 Building on the theoretical foundations of, and insights from, the development and psychometric evaluation of these diagnosis-specific decision tools, the Transdiagnostic Decision Tool was developed for use in heterogeneous patient groups, in patients with a diagnosis for which no diagnosis-specific decision tool is available and in patients without a clear primary diagnosis.…”