정신건강을 위한 보건시설체계에 관한 연구

The financial impact of the rising number of pediatric mental health hospitalizations is unknown. Therefore, this study assessed costs, reimbursements, and net profits or losses for 111,705 mental health and non-mental health medical hospitalizations in children's hospitals with use of the Pediatric Health Information System and Revenue Management Program. Average financial margins were calculated as (reimbursement per day) - (cost per day), and they were lowest for mental health hospitalizations ($136/day), next lowest for suicide attempt ($518/day), and highest for other medical hospitalizations ($611/day). For 10 of 17 hospitals, margin per day for mental health hospitalizations was lower than margin per day for other medical hospitalizations. For these 10 hospitals, the total net loss for inpatient and observation status mental health hospitalizations, compared with other medical hospitalizations, was $27 million (median, $2.2 million per hospital). Financial margins were usually lower for mental health vs non-mental health medical hospitalizations.

ObjectiveUnderstanding differences in outpatient care before and after mental health hospitalization for adolescents from diverse backgrounds is critical to ensuring effective and responsive care. The objective of the current study was to examine outpatient mental health care in the two years before and 30 days after a mental health hospitalization for adolescents from immigrant, refugee and non-immigrant backgrounds.MethodThis retrospective, population-based cohort study, conducted in British Columbia (BC), Canada, analyzed linked health service utilization data (practitioner billings, hospitalizations) and migration records to track outpatient care before and after mental health hospitalization. The study included adolescents (ages 10–18) with an unscheduled/urgent mental health hospitalization between January 1, 2008 and December 31, 2016 (n = 5,314) from a cohort of adolescents in 10 of the largest school districts in BC (between 1996 and 2016). The main analyses examined outpatient mental health visits (e.g., general practitioner/psychiatrist) (i) in the two years before hospitalization and (ii) in the 30 days after discharge. Sub-analyses focused on outpatient visits with psychiatrists.ResultsOverall, 30.4% had no outpatient mental health visit in the two years before hospitalization and 45.1% had none in the 30 days following discharge. First-generation immigrants and refugees and second-generation immigrant adolescents were significantly less likely than non-immigrants to have had an outpatient mental health visit in the two years before mental health hospitalization (aOR1st_gen_immg = 0.79, 95% CI, 0.63 to 0.98; aOR2nd_gen_immg = 0.75, 95% CI, 0.61 to 0.93; aOR1st_gen_ref = 0.40, 95% CI, 0.26 to 0.64). Second-generation immigrant adolescents were significantly more likely than non-immigrants to have had any outpatient mental health visit in the 30 days following hospitalization (aOR2nd_gen_immg = 1.34, 95% CI, 1.09 to 1.65).ConclusionsResults suggest outpatient care before and after mental health hospitalizations is limited for many adolescents in BC and differed by migration background. Implications for meeting standards of care are discussed.Plain Language Summary TitleMental health-related care from a doctor/psychiatrist before and after mental health hospitalization for adolescents from immigrant, refugee, and non-immigrant backgrounds in British Columbia

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

The authors provide an overview of privatization, a major trend in mental health policy, focusing in particular on the reasons for and consequences of substantial growth and change in ownership of private psychiatric hospitals; the proportion of all nonfederal psychiatric inpatient beds in private facilities has increased from less than 10% in 1970 to 35% today. It is estimated that between 1970 and 1986, the proportion of total nonfederal psychiatric inpatient beds in the United States that were under corporate for-profit auspices increased from about 1% to 15%. The authors distinguish and examine several aspects of privatization and assess the implications of these changes for psychiatry and for public policy and research.

Applied behavior analysis is a widely used intervention for autistic youth, though its mental health impacts remain under-researched. This study aims to investigate the association between applied behavior analysis therapy and post-traumatic stress disorder, suicidality, mental health hospitalization rates, and length of mental health hospitalizations using a national database of privately insured youth under 18. We matched 17,120 autistic youth who received applied behavior analysis with a control group of autistic youth with no record of applied behavior analysis and clustered them into four applied behavior analysis dose groups using two-stage bisecting k-medians clustering. Then, we used negative binomial regression and logistic regression to compare outcomes for the applied behavior analysis and non-applied behavior analysis groups. Overall, applied behavior analysis receipt was associated with 30% higher odds of experiencing a mental health hospitalization (odds ratio = 1.30, p < 0.001) and a 32% higher incidence rate of these hospitalizations (incidence rate ratio = 1.32, p < 0.001). Our analysis found no relationship between applied behavior analysis dosing and the other tracked mental health outcomes. These results indicate the need for more quantitative analysis with more comprehensive records of applied behavior analysis receipt to fully investigate claims of ABA resulting in adverse adult mental health outcomes.Lay abstractAutistic youth often receive applied behavior analysis (ABA) therapy, but some autistic adults who had ABA as youth say it harmed their mental health as adults. We looked at the relationship between ABA and post-traumatic stress disorder (PTSD), suicidality, mental health hospitalization rates, and length of mental health hospitalizations among autistic youth. We used private health insurance claims data to look at how ABA receipt was related to those mental health outcomes. We divided autistic youth into groups based on how much ABA they received, so we could see if different amounts of ABA had different associations with mental health. There were 17,120 autistic youth in the group that did not receive ABA, and 17,120 autistic youth in the group that did receive ABA. In this sample, ABA therapy was associated with a greater use of acute mental health services; autistic youth in the ABA group had an overall risk that was 30% higher for mental health hospitalizations; and a 32% greater frequency of mental health hospitalizations. These results suggest that there may be a relationship between mental health hospitalizations and getting ABA. However, more work is needed to fully understand the impact of ABA therapy on mental health outcomes.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

An Update on the South Carolina Trauma Initiative

This study assessed trends in provision of trauma-specific services, defined as dedicated programming for persons with a history of trauma, in US Substance Use Disorder (SUD) and other Mental Health (MH) facilities. Facility level data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey (2015-2019) were used to examine trends in provision of trauma specific-services. Trauma specific service provision trended up significantly between 2015 and 2019. In 2019, they were more commonly offered at MH facilities (49.9%) than SUD facilities (42.7%). Licensing by state SUD authorities were associated with provision of trauma-specific services at both MH (Adjusted Odds Ratio (AOR) = 1.23, 95% Confidence interval (CI) = 1.18-1.47, p < .001) and SUD (AOR = 1.19, 95% CI = 1.04-1.37, p = .012) facilities. The proportions of facilities that offer trauma-specific services were correlated within states (Pearson's r = .44, p = .001). State policies to implement trauma screening at public facilities were associated with higher odds of offering trauma-specific services in MH (AOR = 1.31, 95% CI = 1.04-1.64, p = .021) and SUD (AOR 1.51, 95% CI = 1.19-1.12, p = .001) facilities; whereas, state implementation of trauma-specific CBT at public facilities was associated with higher odds of this outcome only in MH facilities (AOR = 1.23, 95% CI = 1.01-1.51, p = .043). Although trauma-specific services trended up significantly, fewer than half of treatment facilities offer such services nationally. Certain facility characteristics, such SUD authority certification, are associated with trauma-specific services. Variability among states in these services is linked to state policy. Increased efforts by states may be an effective point of intervention to further disseminate trauma-specific services.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. We aimed to conduct an economic analysis of implementing collaborative care in 9 outpatient general mental health clinics. Analyses were derived from a stepped wedge hybrid implementation-effectiveness trial. We conducted cost-minimization analyses from the health system perspective, incorporating implementation costs, outpatient costs, and inpatient costs for the year before collaborative care implementation and the implementation year. We used a difference-in-differences approach and conducted 1-way sensitivity analyses to determine the robustness of results to variations ±15% in model parameters, along with probabilistic sensitivity analysis using Monte Carlo simulation. Our treatment group included 5507 patients who were initially engaged in care within 9 outpatient general mental health teams that underwent collaborative care implementation. We compared costs for this group to 45,981 control patients who received mental health treatment as usual at the same medical centers. Collaborative care implementation cost about $40 per patient and was associated with a significant decrease in inpatient costs and a nonsignificant increase in outpatient mental health costs. This implementation was associated with $78 in cost savings per patient. Monte Carlo simulation suggested that implementation was cost saving in 78% of iterations. Collaborative care implementation for mental health teams was associated with significant reductions in mental health hospitalizations, leading to substantial cost savings of about $1.70 for every dollar spent for implementation.

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.

Meso-level Comparison of Mental Health Service Availability and Use in Chile and Spain

The objective of this study was to investigate the engagement between healthcare professionals and users of mental healthcare at the individual level in a mental health hospital. A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews were conducted with nurses and other health professionals at a mental health hospital in Copenhagen and were explored using Fairclough's discourse analysis framework. This study shows how users can be subject to paternalistic control despite the official aim that user involvement be an integral part of the care and treatment offered. As evidenced in discussions by health professionals, the users were involved in plans based on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in mental health hospitals.

Hospitalization Patterns for Psychiatric Disorders Across the Lifespan in Australia From July 1998 to June 2005

BackgroundCommunity residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI).AimsTo investigate use of community and specialised mental health care services and costs in patients with SMI the first 12 months after discharge from a mental health hospital (MHH), comparing community residential aftercare (CRA) and treatment as usual.MethodsAn open parallel group randomised controlled trial with 41 participants. Data on use of specialist services (hospital, ambulant treatment and outpatient treatment) and community services (residential stays, home help, home care nursing, mental health consultation) were collected from specialist and community registers and health records.ResultsFor the primary outcome, utilisation of community mental health services, the intervention group used, on average, 29% fewer hours (mean differences − 21.6 h, 95% CI -93.1 to 44.9, p = .096) with a cost saving of 29% (mean differences − 1845 EUR, 95% CI -8267 to 4171, p = .102), but the estimates were imprecise. For the secondary outcome, the study groups had the same total number of inpatient days (66 days), but the intervention group had on average of 13.4 fewer inpatient days in the mental health hospital (95% CI -29.9 to 0.9. p = .008). The number of inpatient admissions (mean difference − 0.9 admissions, 95% CI -3.5 to 1.5, p = .224) and readmissions (− 0.8, 95% CI -2.5 to 0.9. p = .440) was lower in the intervention group. The intervention group had on average a total cost saving of 38.5% (mean differences − 23,071 EUR, 95% CI -45,450 to 3027. p = .057). A post hoc multivariable regression analysis controlling for baseline characteristics gave a reduction in total cost in favour of the intervention group of − 19,781 EUR (95% CI -44,072 to 4509, p=,107).ConclusionIn this study, it was not possible to draw a definite conclusion about the effect, due to the small sample and imprecision of the estimates. The direction of the results and size of the point estimate, in addition to findings in other studies, indicates that transferring patients ready for discharge from mental hospital to community residential aftercare can have the potential to reduce total consumption of health services and costs without increased hospital admissions.Trial registrationRegistered in clinicaltrials.gov (NCT01719354)