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PubMed2003

Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review.

BACKGROUND: Inequalities of service use across ethnic groups are important to policy makers, service providers and service users. AIMS: To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings. METHOD: A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate. RESULTS: Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33-5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments. CONCLUSIONS: There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.

Commitment of Persons with Psychiatric Disorders↗

PubMed2002

Adolescent girls' use of the Internet for health information: issues beyond access.

Whilst the "digital divide" in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illness episodes. This exploration with future health service users highlights important questions for further study.

Adolescent↗

PubMed2002

Meeting patient expectations: healthcare professionals and service re-engineering.

A central theme underpinning the reform of healthcare systems in western economies since the 1980s has been the emphasis on reorienting service provision around the patient. Healthcare organizations have been forced to re-appraise the design of the service delivery process, specifically the service encounter, to take account of these changing patient expectations. This reorientation of healthcare services around the patient has fundamental implications for healthcare professionals, specifically challenging the dominance of service professionals in the design and delivery of health services. Utilizing a qualitative methodological framework, this paper explores the responses of healthcare professionals to service redesign initiatives implemented in acute NHS hospitals in Scotland and considers the implications of such professional responses for the development of patient-focused service delivery. Within this, it specifically examines evolving professional perspectives on the place of a service user focus in a publicly funded healthcare system, professional attitudes towards private sector managerial practices, and the dynamics of changing professional behaviour.

Attitude of Health Personnel↗

PubMed2004

Does anyone care about names? How attendees at substance misuse services like to be addressed by health professionals.

OBJECTIVE: To determine the preference of substance misusers for the terms 'patient', 'client' and 'service user' in the context of their contact with health professionals, if they consider substance misuse problems to exist appropriately under the category of mental health problems and if they consider themselves to have mental health problems. METHODS: A self-completion questionnaire was administered to 150 National Health Service and private in- and outpatients with alcohol, drug and smoking problems. RESULTS: The majority (54%) preferred the term 'patient', felt substance misuse problems was a category of mental health problems (59%), even though the majority (62%) did not consider themselves to have a mental health problem. Broadly similar preferences were found for those attending drug services and alcohol services whilst those attending the smoking cessation service were less likely to consider it an appropriate location or description. DISCUSSION: The majority of substance misusers preferred to be called 'patients'. The location of substance misuse services within mental health provision was widely tolerated.

Adult↗

PubMed1998

Mental health. Home alone.

Carers of people diagnosed with schizophrenia want more support and greater involvement in the care of the service user. Access to 24-hour support is highly rated. Almost half the carers in this study received no support from anyone--professional or otherwise.

Caregivers↗

PubMed2001

User involvement in mental health branch education: client review presentations.

This paper will present the work of users, students and lecturers involved in the delivery of Mental Health pre-registration education, focusing on client assessment. Users from local mental health representative organizations, attend a series of college-based sessions to evaluate student's client review presentations, in which individual students explicitly and critically reflect upon a mental health assessment of a client in which they have participated. The user contributions are intended to raise student's awareness of client-centred perspectives, particularly in terms of the various possible interpretations that may be attributed to assessment data gathered about the client. The sessions seek to develop a learning approach, which will develop and consolidate a partnership in curriculum delivery between mental health service users and nursing education. This method of working has been evaluated by a previous study, and indicates that this method has an important influence on student's approaches to identifying clients needs and subsequent care delivery. This paper will focus on the organizational pre-requisites that are desirable, to implement this method of teaching and learning, including philosophical issues, contract arrangements, classroom activities, supervision, consideration of ethical dilemmas and reflective outcomes.

Educational Measurement↗

PubMed1993

Requirements for PACS: users' perspective.

The applications for which picture archiving and communication systems (PACS) will be used must dictate the technological requirements. Technology-driven integrated PACS have been implemented and tested in a variety of clinical environments. PACS do not generate new revenues, albeit they may affect the bottom line of health care delivery systems through increased efficiency of radiology and, perhaps more important, of the other physicians who use radiologic services. User performance expectations require that trade-offs are evaluated and compromises are made when PACS are designed using currently available technology. In this report, functional requirements for clinical PACS are discussed. These include reliability, speed, ease of use, connectivity, and upgradability. The advantages and disadvantages of specific choices are presented from a utility perspective of an end user.

Computer Communication Networks↗

PubMed2006

Inequity in mental health care under Canadian universal health coverage.

OBJECTIVE: Previous research has produced conflicting evidence about socioeconomic disparities in mental health care under universal health coverage in Canada. This study sought to determine equity in the delivery of ambulatory services from psychiatrists and family physicians for mental health problems in this setting. METHODS: Outpatient billing claims and neighborhood socioeconomic status were examined with cross-sectional analysis. The study area consisted of the central southern portion of the city of Toronto, Ontario, including the city's downtown core. This urban setting is an economically and culturally diverse area. A total of 1,221 homogeneous enumeration areas (local neighborhoods) were surveyed, and data were examined for the 746,141 residents of these areas who had had a health visit in 2000. Rates of mental health visits to family physicians and psychiatrists were compared across socioeconomic quintiles. Socioeconomic status was determined according to educational attainment in the enumeration area. RESULTS: Claimants from neighborhoods with the highest socioeconomic status were 1.6 times as likely as those from neighborhoods with the lowest socioeconomic status to use psychiatric care. Among persons who received care from a psychiatrist, claimants from neighborhoods with the highest socioeconomic status had significantly more psychiatric claims than those from neighborhoods with the lowest socioeconomic status. No significant gradients were found for either sex for any use of mental health care provided by family physicians. Among females, service users from the highest socioeconomic areas had more mental health visits to family physicians than those from the lowest socioeconomic areas. CONCLUSIONS: Marked socioeconomic disparities were found in the use of care from a psychiatrist. Unlimited coverage of physician-provided mental health care is insufficient to fairly distribute services to those most in need.

Adult↗

PubMed1992

Reaching vulnerable populations: a framework for primary service role expansion.

An ecological framework is presented for assessing the feasibility of expanding the roles of primary service providers. Role conflict, interprofessional tensions, role anomalies, training and supervision, practitioners' tacit knowledge, and service user acceptance are among the factors assessed. The use of this conceptual framework for reaching a broader client population is discussed, together with its implications for professional practice.

Community Mental Health Services↗

PubMed2006

Silenced complaints, suppressed expectations: the cumulative effects of home care rationing.

In many Western welfare jurisdictions, publicly provided home care is being eroded and its provision increasingly individualized. These shifts are of a particular significance for older women, a group for whom supportive home care has been an important buttress against the social and physical jeopardies of old age. A longitudinal, qualitative study of such women in Ontario, Canada, spanned the implementation of managed competition in home care and a period of rapid privatization and service rationing. Study participants experienced cuts and, stemming from increasingly precarious employment conditions in the home care workforce, inconsistent care providers. These changes generated distress, insecurity, and isolation in participants' lives. This article explores how their complaints about insufficient care were silenced: by fear, hopelessness, and the cultural injunction to put a stoic and selfless face on the limitations of old age. Their accounts reveal how large material and discursive shifts and state restructuring come to penetrate identity, feeling, and speech. This examination of the silencing of complaint at home care's front lines reveals the cumulative effects of rationing; it also illuminates how, if heard, service users' voices can inform collective struggles to resist the degradation of home care and reposition older people in relation to the state.

Adult↗

PubMed1997

Changing childbirth--the midwifery managers' tale.

This paper concerns Maternity Services. It begins by describing the development of the current policy in Britain which culminated in the report Changing Childbirth. It proceeds to describe a qualitative investigation in which a group of Heads of Midwifery Service in one health region were interviewed concerning their views about the basic recommendations of the report and their experiences concerning the feasibility of its implementation by 1998. On the basis of its evidence, the study concludes the policy is failing to be fully realized due to both a lack of earmarked resources and confused objectives which are not fully accepted by professionals and are not understood by service users. The findings demonstrate that the Heads of Midwifery believe that what was proposed as a bold and innovative policy has become no more than lukewarm advice. The conduct of the study is described in detail to illustrate how operational managers can research the ways in which policies are influencing service delivery in their field of practice.

Attitude of Health Personnel↗

PubMed1995

Setting standards.

A method of involving users and providers in residential care for older people was used to develop standards of care and outcome indicators. The standards were prioritized using the paired comparison technique. Describes the method and the outcomes of the processes. These include 28 standards relating to the quality of care developed by providers and service users.

Aged↗

PubMed1997

Caught in the "traps of managed competition"? Examples of Russian health care reforms from St. Petersburg and the Leningrad region.

Elements of a "managed market" for health services have been introduced into the Russian health care system, which under the Soviet regime was run as a comprehensive state-managed system. The authors examine the recent development of health service reforms in a case study of the city of St. Petersburg and the surrounding Leningrad region. Evidence from key informants and a local survey of service users shows how alternative models of the managed market are being introduced in different parts of the study area. A critical review of the market-oriented strategies for reform emerging in the case study suggests that such reforms carry risks associated with the "traps of managed competition." Future policy for health service systems in Russia must take these risks more fully into account.

Adolescent↗

PubMed1998

'We're doing it already ...': adult protection in mental health services.

This paper explores the implementation of generic adult protection policies in mental health services, both in terms of conceptual issues about the nature and thresholds of abuse which are identified and/or tolerated within different settings, and in relation to existing structures for working on risk assessment, such as the Care Programme Approach and Supervised Discharge. The paper asks if resistance from mental health workers to new adult protection procedures reflects a reality that they have 'been doing it already' or whether there is a deeper resistance to acknowledgement of abuse issues in the lives of service users, and to the burden which such knowledge places on workers who are already stretched to the limit.

Adult↗

PubMedDate not supplied

A dynamic planning framework for nursing homes.

The application of market opportunity analysis offers an extensive information base as well as important implications for market need assessment and cost containment for nursing homes and other organizations. The adaptation of MOA is concerned with alerting the institution to the size and potential of the market, better understanding of the market characteristics, and means for more efficient provision of nursing care and other services. Organized, ongoing information acquisition should enable nursing home administrators to plan and act with foresight rather than react retrospectively (or not at all) to market demands. With systematic planning and adoption of a service user orientation, nursing homes need not be overburdened or ill prepared to meet the diverse and changing needs of the growing segment of the aging.

Health Facility Planning↗

PubMed1997

Staff strategies and explanations for intervening with challenging behaviours: a replication in a community sample.

Carers' beliefs about challenging behaviours may partially determine their behavioural responses to them. The present study replicated previous work on the beliefs of institution staff and their explanations about interventions for challenging behaviours (Hastings 1996) with a sample of 56 community staff. Many immediate intervention strategies, and the staff motivation for these choices, were in conflict with behavioural approaches to challenging behaviour and would be considered counter-habilitative from this perspective. Staff were able to describe appropriate longer-term interventions. These basic findings confirmed those of previous research with institution staff. However, tentative comparisons suggested that community staff were more likely than institution staff (from previous research) to describe interventions involving the building of relationships with service users and the identification of the underlying causes of the behaviours.

Activities of Daily Living↗

PubMed1999

Eliciting user perspectives on what works.

Social care research has moved gradually in recent years to include the subjective perspective. Dementia care, which in many ways is still in its infancy, has lagged behind in this development, and much research has been informed by the carer rather than the person with dementia. As a young subject area, it is right that dementia care should look around for lessons that can be learned from other disciplines. This paper will consider how research with people with learning difficulties has developed a culture for hearing the views of service users. It will outline various methodologies, with considerations of their strengths and weaknesses. The paper will then review research in dementia care which features the subjective experience, and will finally draw out lessons and identify possible ways forward.

Aged↗

PubMed2005

Substance abuse and mental health services for children and adolescents.

This study examines the initial effects of the Massachusetts Mental Health and Substance Abuse Program on 24-hour care for children and adolescents. Analysis of Medicaid claims shows that under managed care, access to 24-hour services, the number of service users, and admissions increased, while length of stay and expenditures decreased. The decomposition of the savings indicated that although the increase in admissions would have added an additional 2.7 million dollars to expenditures without managed care, the carve-out saved 9.1 million dollars in the first year through changes in length of stay, service settings, and price per day. The managed care variable was not significant in the regression models examining rapid readmission.

Adolescent↗