Evaluating a community‐based mental health service focusing on severe mental illness. The Verona experience

Tansella, Michele; Amaddeo, Francesco; Burti, Lorenzo; Lasalvia, Antonio; Ruggeri, Mirella

doi:10.1111/j.1600-0447.2005.00724.x

Cited by 50 publications

(40 citation statements)

References 14 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Higher costs resulted for patients with an ongoing episode, which one can relate to the profile of these patients, who were likely to have a more severe diagnosis, to be single, a resident in a psychiatric residential facility or sheltered accommodation and unemployed. These seem to be the most chronic patients, for whom, as described in Tansella et al (2006), resources are targeted by our community-based services to provide integrated interventions such as medication, family support and social care. Accordingly, the costs of their care are higher.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

Donisi

Jones

Pertile

et al. 2011

Epidemiol Psychiatr Sci

Self Cite

View full text Add to dashboard Cite

This is the unspecified version of the paper.This version of the publication may differ from the final published version. Background. Previous studies have attempted to forecast the costs of mental health care, using clinical and individual variables; the inclusion of ecological measures could improve the knowledge of predictors of psychiatric service utilisation and costs to support clinical and strategic decision-making. Permanent repository linkMethods. Using a Psychiatric Case Register (PCR), all patients with an ICD-10 psychiatric diagnosis, who had at least one contact with community-based psychiatric services in the Verona Health District, Northern Italy, were included in the study (N = 4558). For each patient, one year's total cost of care was calculated by merging service contact data with unit cost estimates and clinical and socio-demographic variables were collected. A socio-economic status (SES) index was developed, as a proxy of deprivation, using census data. Multilevel multiple regression models, considering socio-demographic and clinical characteristics of patients as well as socioeconomic local characteristics, were estimated to predict costs.Results. The mean annual cost for all patients was 2,606.11 Euros; patients with an ongoing episode of care and with psychosis presented higher mean costs. Previous psychiatric history represented the most significant predictor of cost (36.99% R 2 increase) and diagnosis was also a significant predictor but explained only 4.96% of cost variance. Psychiatric costs were uniform throughout the Verona Health District and SES characteristics alone contributed towards less than 1% of the cost variance.Conclusions. For all patients of community-based psychiatric services, a comprehensive model, including both patients' individual characteristics and socioeconomic local status, was able to predict 43% of variance in costs of care.

show abstract

Section: Discussionmentioning

confidence: 99%

“…More information on the South Verona PCR and on the research setting can be found elsewhere (Tansella et al 2006).…”

Section: Methodsmentioning

confidence: 99%

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

Donisi

Jones

Pertile

et al. 2011

Epidemiol Psychiatr Sci

Self Cite

View full text Add to dashboard Cite

show abstract

“…The aim of this paper was to study mortality, causes of death and associated risk factors among psychiatric patients followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services and has been monitored by a case register since 1978 (Tansella et al 2006). This research allowed us to repeat the mortality analyses published in a previous study by Amaddeo et al (1995) conducted in South Verona for a time period of 10 years, on a sample followed up for a twofold longer period, also adding a detailed analysis of causes of death that was not possible to perform in our previous study because of the small sample size.…”

Section: Introductionmentioning

confidence: 99%

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

et al. 2009

Self Cite

View full text Add to dashboard Cite

Background. Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.Method. All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.Results. The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95 % confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95 % CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95 % CI 142.5-328.6) and personality disorders (20.87, 95 % CI 5.2-83.4).Conclusions. This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

show abstract

“…Esse modelo é definido com base em três componentes essenciais: a diminuição das admissões hospitalares pela provisão de serviços comunitários; a desospitalização, após preparação, de pacientes internados por longos períodos; a criação e manutenção de uma rede de serviços na comunidade para atender a esses pacientes 4,8,9 . Os modelos mais significativos surgiram na Inglaterra, na França e nos Estados Unidos.…”

Section: A Reforma Da Assistência Psiquiátricaunclassified

Reforma psiquiátrica e serviços residenciais terapêuticos

Vidal

Bandeira

Gontijo

2008

J. bras. psiquiatr.

View full text Add to dashboard Cite

Palavras-chavePsiquiatria, desinstitucionalização, reforma psiquiátrica, moradias assistidas. resumo objetivo: Apresentar os principais aspectos da reforma psiquiátrica ocorrida em diversos países e no Brasil, destacar a política de reinserção social dos pacientes e descrever os procedimentos da desospitalização ocorridos em Barbacena, Minas Gerais, com ênfase nas residências terapêuticas e nas intervenções de reabilitação psicossocial. método: Pesquisa bibliográfica realizada nas fontes eletrônicas Medline e Lilacs (1990Lilacs ( a 2006, com os seguintes descritores: deinstitutionalization, psychiatric reform, community-based treatment, psychosocial rehabilitation. Descrição do processo de implantação das residências terapêu-ticas (RT) por meio de consulta aos documentos da Prefeitura de Barbacena e de observação direta das residências. resultados: A maioria dos trabalhos selecionados indicou que pacientes desospitalizados apresentam melhora na autonomia, na interação social, no nível global de funcionamento e na qualidade de vida. A desospitalização implica a existência de serviços comunitários com diversos níveis de atenção e requer a presença de profissionais qualificados e programas de reabilitação efetivos. Em Barbacena, o processo de desospitalização teve início em 2000. Atualmente existem 24 RTs no município. Conclusão: Apesar das dificuldades na sua implantação, os tratamentos de base comunitária tornaram-se o modelo dominante de cuidados psiquiátricos. Para os pacientes desospitalizados, as RTs têm importante papel no processo de reinserção social.

show abstract

Evaluating a community‐based mental health service focusing on severe mental illness. The Verona experience

Abstract: Developing community-based mental health care requires a series of coordinated actions that need to be pursued over a long period of time. Service evaluation, including costs assessment, is an important part of this exercise.

Cited by 50 publications

References 14 publications

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

The difficult task of predicting the costs of community-based mental health care. A comprehensive case register study

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

Reforma psiquiátrica e serviços residenciais terapêuticos

Contact Info

Product

Resources

About