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Activating people to address their health care needs: learning from people with lived experience of chronic illness
- Authors:
- STANHOPE Victoria, HENWOOD Benjamin F.
- Journal article citation:
- Community Mental Health Journal, 50(6), 2014, pp.656-663.
- Publisher:
- Springer
One of the primary goals of health care reform is improving the quality and reducing the costs of care for people with co-morbid mental health and physical health conditions. One strategy is to integrate primary and behavioural health care through care coordination and patient activation. This qualitative study using community based participatory research methods informs the development of integrated care by presenting the perspectives of those with lived experience of chronic illnesses and homelessness. Themes presented include the internal and external barriers to addressing health needs and the key role of peer support in overcoming these barriers. (Edited publisher abstract)
Starting today: the future of mental health services: final inquiry report
- Author:
- MENTAL HEALTH FOUNDATION
- Publisher:
- Mental Health Foundation
- Publication year:
- 2013
- Pagination:
- 66
- Place of publication:
- London
More is spent across the UK on mental health services than on any other area of health. The economic impact of poor mental health is estimated to be over £100 billion to the economy each year in England alone. Despite this, we know that the care and treatment offered to people with mental health problems is variable. This final report of the Mental Health Foundation's year-long Inquiry into the future of mental health services sets out some key messages as to what mental health services need to do, to ensure that they are ready to tackle the mental health needs of the UK population in 20-30 years’ time. It indicates that while mental health services are already straining at the seams, they face even greater pressures in the future: a growing, and ageing population; persistently high prevalence rates of mental disorders among adults and children; increasing levels of co-morbid mental and physical health problems; and funding constraints that are likely to last for many years. The Inquiry looked at some key demographic and societal factors which will affect future mental health services. Six key themes are identified to make mental health services fit for purpose for the 21st century: personalising services; integrated care; health needs across the life span; workforce development; research and new technologies; and public mental health. (Edited publisher abstract)
Long-term conditions and mental health: the cost of co-morbidities
- Authors:
- NAYLOR Chris, et al
- Publisher:
- King's Fund
- Publication year:
- 2012
- Pagination:
- 32p.
- Place of publication:
- London
Many people with long-term physical health conditions also have mental health problems. This report shows that between 12-18% of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing. This comes to a total of £8-£13 billion in England each year. This additional cost can be attributed to the extra difficulties in treating physical illness among patients with mental health problems, including poorer self-management. However, the cost is not just a financial one. Patients with a long-term condition and co-existing mental health issue face poorer clinical outcomes and a significantly lower quality of life than people with a physical health problem alone. The report concludes that the costs of caring for people with long-term conditions could be reduced if the NHS was to manage the mental health needs of these people more effectively. Care for people with long-term conditions could be improved by better integrating mental health support with primary care and chronic disease management programmes. To rise to this challenge, commissioners and providers need to strengthen the interface between mental and physical health care, and health professionals of all kinds will need to be equipped with basic mental health knowledge and skills.
Dual diagnosis resource needs in Spain: a national survey of professionals
- Authors:
- SZERMAN Nestor, et al
- Journal article citation:
- Journal of Dual Diagnosis, 10(2), 2014, pp.84-90.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals’ perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. The authors conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders. (Edited publisher abstract)
Can data solve the comorbidity puzzle?
- Authors:
- STREET Andrew, KASTERIDIS Panos, MARTIN Jeremy
- Journal article citation:
- Health Service Journal, 124(6394), 11 April 2014, pp.30-32.
- Publisher:
- Emap Healthcare
In South Somerset, the county council, district hospital, community provider and clinical commissioning group have set up the Symphony project to develop a model of integrated care to improve services and increase efficiency. It is designed to improve collaboration between different care settings. Part of the project involved building a large dataset comprising information about each individual in the population. The data found that for people who have a chronic condition, it is unusual for them to have only one condition. The project has found that is this multi-morbidity, not age, that drives the demand for health and social care. This article looks at the findings of the project to date and outlines some of the costs involved in caring for people according to care setting and condition. (Edited publisher abstract)
Health care integration for formerly homeless people with serious mental illness
- Authors:
- WENSTEIN Lara Carson, et al
- Journal article citation:
- Journal of Dual Diagnosis, 9(1), 2013, pp.72-77.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: The primary objective of this study was to evaluate medical health and health care in a programme of integrated primary and behavioral health care for people with experiences of homelessness and mental illness. Methods: Using a retrospective chart review, we examined health status and rates of health care quality indicators in a group of 123 Housing First participants with histories of chronic homelessness and diagnoses of serious mental illness, including a subgroup of 43 participants who received integrated medical and behavioural health care. Results: In addition to having serious mental illness, participants had high rates of comorbid chronic disease and risk behaviour: 76% had at least one chronic disease, 59% had two or more chronic diseases, 6.5% had HIV, and 83% used tobacco. The integrated care programme subgroup had relatively high rates of documentation of some health care quality indicators: 62% with body mass index, 73% with blood pressure, 77% with tobacco use history, 87% with substance use history. Conclusions: Our study confirms that people with experiences of homelessness and serious mental illness also have serious medical comorbidities and documents the feasibility of providing on-site integrated primary care and health screenings in supportive housing programmes. (Publisher abstract)
Enhanced case management versus substance abuse treatment alone among substance abusers with depression
- Authors:
- STRILEY Catherine W., et al
- Journal article citation:
- Social Work Research, 37(1), 2013, pp.19-25.
- Publisher:
- Oxford University Press
This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to enhanced case management (ECM) (n = 64) or treatment as usual (TAU) (n = 56). Both groups were followed up at six and 12 months. Participants' current clinical status across a broad range of domains in the past 90 days was assessed using the Global Appraisal of Individual Needs and included their Depressive Symptom Scale, Homicidal–Suicidal Thought Index, and Mental Health Treatment Index scores. The findings did not reveal any statistically significant effects of ECM on outcome measures. However, in view of the high rates of adverse treatment outcomes among comorbid groups, including suicide, the finding of a clinically significant reduction in homicidal and suicidal thoughts warrants further research; the comprehensive approach to treatment tested may be especially helpful to depressed substance abusers with such ideations. (Publisher abstract)
Translating evidence-based practice for managing comorbid substance use and mental illness using a multimodal training package
- Authors:
- LOUIE Eva, et al
- Journal article citation:
- Journal of Dual Diagnosis, 14(2), 2018, pp.111-119.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: Comorbid mental health and substance use problems are highly prevalent in substance use treatment settings and generally lead to poorer treatment outcomes. Pathways to Comorbidity Care (PCC) is a multimodal training program developed to encourage an integrated service approach to improve clinicians capacity to identify and manage comorbid substance use and mental health outcomes within on relevant subjects such as motivational interviewing and cognitive behavioural therapy, individual clinical consultation, and feedback with a senior clinical psychologist. The PCC also includes an online portal containing comorbidity resources including manuals, guidelines, and booster webinars. Finally, the evaluation of PCC implementation is described. Conclusions: Drug and alcohol services need (Edited publisher abstract)
Comorbidities: a framework of principles for system-wide action
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2014
- Pagination:
- 7
- Place of publication:
- London
This document sets out the current challenges faced in the health and social care system in treating people with two or more long term health conditions. Two types of comorbidities can be identified, requiring a different emphasis of action: those mostly due to increased life expectancy and longer exposure to risk factors over time; and those caused by more intense exposure to risk factors, particularly smoking, obesity, alcohol and physical inactivity. The document outlines a framework of principles and actions that might inform high level discussions on programme and service planning across agencies to support redesigning the health and social care system around whole people and the needs. These principles focus on health promotion and prevention; the role of wider determinants such as education, housing and employment; population needs; research and guideline development and use; people and patient participation; parity of esteem for mental health; and coordinated systems and payment reform. Also contains a list of useful resources. (Edited publisher abstract)
The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somerset’s Symphony Project
- Authors:
- KASTERIDIS Panos, et al
- Publisher:
- University of York. Centre for Health Economics
- Publication year:
- 2014
- Pagination:
- 60
- Place of publication:
- York
By analysing a large dataset, this report examines patterns of health and social care utilisation and costs for the local South Somerset population to identify which groups of people would most benefit from better integrated care. The study adopted four criteria to identify those groups who would most benefit from an integrated care approach, those with a high frequency of occurrence of underlying conditions; a high cost of care; utilisation of services across different settings; and a local consensus that changes to the pathway were feasible. The study looked at eight broad settings: primary care episodes and prescribing; acute inpatient and daycare; acute outpatient; mental health; community care; social care; and continuing care. The analysis identifies those groups which are the highest users of services by activity and cost. The report concludes that the more co-morbidities a person has, the more likely they are to require care across diverse settings, and the higher their costs. They would also most benefit form improved integrated care. Chaper 8 also provides analysis of costs for those with dementia.. (Edited publisher abstract)