Estimating Local-Area Needs for Psychiatric Care: A Case Study

Lesage, Alain; Clerc, D; Uribe, I.; Cournoyer, Jocelyne; Fabian, Jose; Tourjman, V.; Haaster, Ian van; Ch, Chang

doi:10.1192/bjp.169.1.49

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…In our investigation, we were able to satisfy the quality criteria proposed by Hafner 3 : the beginning of the follow-up period was the same for the whole cohort; the beginning was close to illness onset as it was the first admission for a first schizophrenia episode; the probands were representative of all illness cases in the general population, as this was an incidence cohort in a publicly funded health care system, and we knew from a previous study that most sector patients were followed by HLHL 7,11 ; efforts were made to avoid attrition in collecting data from many sources; therefore, we had no data at last follow-up for only 2% of subjects; and even if some data on social outcome were not available for a proportion of subjects (33% at study end), we tried to estimate in which category the dropout subjects would belong by analyzing their predicting factors and their evolution until they were lost to follow-up and by comparing them to the rest of the sample.…”

Section: Study Strengthsmentioning

confidence: 99%

Schizophrenia, An Illness with Bad Outcome: Myth or Reality?

et al. 2011

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Objective: Different myths about schizophrenia endorsed by clinicians maintain the pessimism about outcome thus reducing chances of improvement. There are no recent North American studies on the long-term outcome of first-episode schizophrenia to clarify if these beliefs are myths or reality. Our study describes the long-term outcome (10 to 16 years) of a first-episode schizophrenia incidence cohort (n = 142) in a Canadian urban centre between 1983 and 1999.Method: Clinical and social functioning at different time points were assessed retrospectively from medical files of a catchment area hospital in Montreal. Service use and deaths were noted from provincial databases of physician billings, hospitalization, and vital statistics.Results: Hospitalization days decreased considerably after the first year, with a small minority still needing it episodically after 4 years. Marital and occupational status were generally stable over time, but autonomy in living arrangements worsened. Thirty-three percent of subjects quit the Catchment Area Specialized Psychiatric Services. This group showed better social functioning while they were followed, were hospitalized less afterwards, and had fewer suicides, therefore indicating a better outcome for them. At the end of our study, 15% of the patients still alive were well enough to function without seeking medical help and 25% were not taking antipsychotic medication. Better outcome was predicted by older age at admission, being married, higher premorbid autonomy in living arrangements, and female sex. Conclusion:A significant proportion of first-episode schizophrenia patients achieve moderate long-term outcome, and the stability of global functioning is more frequent than deterioration, as shown in most industrialized countries.Can J Psychiatry. 2011;56(2):92-101. Clinical Implications• The heterogeneity of outcome widens as duration of follow-up increases, and a proportion of schizophrenia patients might function without long-term medication.• Occupational deficit stability suggests it should be the target of early intervention programs to prevent significant deterioration of functioning and of later supported employment rehabilitation approaches.• The decline in autonomous housing suggests early supported housing in the community, in collaboration with relatives, when patients move from their parents' home. Limitations• Our sample covered most of the catchment-area incident schizophrenia patients, but was limited to patients hospitalized at least once.• The functioning of a proportion of subjects could not be assessed until study end, but many of them were functioning without seeking medical help.• No symptomatology measures were included, therefore no correlations could be made between symptoms and functioning.

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Section: Study Strengthsmentioning

confidence: 99%

Schizophrenia, An Illness with Bad Outcome: Myth or Reality?

et al. 2011

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“…However, to serve as benchmarks for other regions, they must be placed into perspective. First, the relative needs of regions are influenced by socioeconomic factors that carry a weight of 1 to 3 (27,28). Such weights have long been used in the UK, which explains the range for the standards proposed by Wing (8), as seen in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Toward Benchmarks for Tertiary Care for Adults with Severe and Persistent Mental Disorders

Lesage

Gélinas

Robitaille³

et al. 2003

Can J Psychiatry

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Background: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities. Objectives: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks. Methods: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients. Results: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100 000 inhabitants. The ideal ratio, according to estimated needs, is 171:100 000. The figure breakdown is as follows: 20:100 000 for long-stay hospital units, 20:100 000 for nursing homes, 40:100 000 for group homes, 40:100 000 for private hostels or foster families, and 51:100 000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces. Discussion: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges. Conclusions: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.

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“…The catch ment area in ques tion was pre vi ously de scribed in Lesage and oth ers (8). Briefly, psy chi at ric ser vices in Montreal were sectorized in the early 1970s.…”

Section: Brief De Scrip Tion Of Ser Vicementioning

confidence: 99%

“…An emer gency clinic op er ates 24 hours daily, 7 days weekly. There are over 4000 con sul ta tions yearly, and it is visited by about 0.6% of the area's pop u la tion an nu ally (8). It is nor mally staffed by med i cal con sul tants in at ten dance and less fre quently by reg is trars and se nior reg is trars, with the backup of con sul tants avail able 24 hours daily.…”

Section: Brief De Scrip Tion Of Ser Vicementioning

confidence: 99%

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Alternatives to Acute Hospital Psychiatric Care in East-End Montreal

et al. 2002

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W Can J Psy chia try, Vol 47, No 1, Feb ru ary 2002 51Ob jec tive: As pres sure mounts to re duce the number of costly acute care beds, gov ernments and the lit era ture pro pose top-down ra tios. Is this rea son able and fair to the re spon sible medi cal of fi cers who, as the key care pro vid ers, will need to ad mit pa tients and de velo p dis charge plans in a reduced-beds en vi ron ment?Method: Treat ing phy si cians of all acute care in pa tients on a given day ( n = 212) and all new acute care ad mis sions over a 2-week pe riod (n = 125) com pleted an adapted ver sion of the Not ting ham Acute Beds Use Sur vey (NABUS) Ques tion naire.Re sults: On a given day, only 62 of 212 in pa tients were un suited for any al ter na tive to acute care hos pi tali za tion. A floor ra tio of 18 acute care beds per 100 000 in habi tants seems ade quate for the catch ment area in ques tion, pro vided that al ter na tives to hos pi tali zation are fully and ef fi ciently avail able. Al ter na tives es sen tially in volve an ar ray of the follow ing: su per vised resi den tial set tings, day hos pi tals, and in ten sive home care (2 to 6 hours weekly). The ra tio of in ten sive home care work ers re quired would be 25 per 100 000 in habi tants.(Can J Psy chia try 2002;47:49-55) Clini cal Im pli ca tions• Cli ni cians rec og nize the need for both hos pi tali za tion and al ter na tives, such as in ten sive home care (IHC), day hos pi tal, and su per vised resi den tial set tings. • At ten tion should be paid not only to the number of beds, but also to the avail abil ity and ra tios of community-based serv ices such as IHC and su per vised resi den tial set tings.• The strength of cur rent as sess ment of needs pre sented here rests not on top-down evalua tion but on bottom-up as sess ment by treat ing psy chia trists. Limi ta tions• In the end, needs as sess ment rests on clini cal judge ment, even when sys tem ati cally re corded, such as is the case here. • The as sess ment of needs for su per vised resi den tial fa cili ties could not be ac com plished with the de sign of this study, but will be on the re search agenda in the near fu ture.

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Estimating Local-Area Needs for Psychiatric Care: A Case Study

Abstract: Resource allocation based on the social indicators modelling method was more consistent with sensible distribution of human resources. None of the methods, however, appear to reflect adequately the severity of caseloads evidenced in the case-control study.

Cited by 14 publications

References 11 publications

Schizophrenia, An Illness with Bad Outcome: Myth or Reality?

Schizophrenia, An Illness with Bad Outcome: Myth or Reality?

Toward Benchmarks for Tertiary Care for Adults with Severe and Persistent Mental Disorders

Alternatives to Acute Hospital Psychiatric Care in East-End Montreal

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