An initial cohort of 115 patients with chronic schizophrenia was studied during the period of care provided by community psychiatry programmes in the Dresden region one month and 12 months post hospital release using, among other instruments, the Berliner Bedürfnisinventar (Berlin Inventory of Care Needs). Thus a subjective need structure was identified over a one-year period, which is related primarily to autonomic basic social competence, a qualitatively sophisticated level of competence with regard to bonding and relationships, as well as (at least threatening) elements of social disintegration. Features characteristic of the course of disease (e.g. length of illness, changes in the psychopathological symptoms) and a factor of self-perceived disorder-related personal changes are the decisive predictors of how the extent of care needed will develop during the study period. Conclusions result from perceived deficits of care (e.g. with regard to employment/occupation). They pertain to a further content and institutionalized establishment of care-providing elements, which are not yet (currently) offered in a system of care that is being restructured along the lines of community psychiatry following German reunification. These conclusions fortify results of an analysis of normative needs for care and the current structure of community-based psychiatric care in the Dresden region.
Background Mental health policies emphasise that caregivers' views of involuntary psychiatric treatment should be taken into account. However, there is little evidence on how caregivers view such treatment. Aims To explore caregivers' satisfaction with the involuntary hospital treatment of patients and what factors are associated with caregivers' appraisals of treatment. Method A multicentre prospective study was carried out in eight European countries. Involuntarily admitted patients and their caregivers rated their appraisal of treatment using the Client Assessment of Treatment Scale 1 month after admission. Results A total of 336 patients and their caregivers participated. Caregivers' appraisals of treatment were positive (mean of 8.5 on a scale from 0 to 10) and moderately correlated with patients' views. More positive caregivers' views were associated with greater patients' symptom improvement. Conclusions Caregivers' appraisals of involuntary in-patient treatment are rather favourable. Their correlation with patients' symptom improvement may underline their relevance in clinical practice.
Objective To develop a toolkit (QuIRC) for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care facilities. Methods The QuIRC was developed by research partners across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece and Portugal. Its content was informed by triangulation of the evidence on critical components of care collated from: a review of care standards in each country; an international literature review; and Delphi exercises. Its final format was agreed by an international panel of rehabilitation and recovery experts. QuIRC scores were compared against service users’ quality of life, autonomy, experiences of care and markers of recovery to assess whether the QuIRc could provide a proxy-assessment of the unit’s promotion of service users’ autonomy and Recovery. Results The finalised tool was used to interview managers from 21 units throughout Germany. One hundred and eighty-eight service users were also interviewed. QuIRC domain ratings were compared by facility type and with service user assessments. The QuIRC’s ability to deliver assessments relevant to Germany’s established systems of change at local, regional and national level will be discussed.
In the provision of mental health care for chronic schizophrenic patients, the specific problems and requirements of long-term community care of suicidal behavior is an area of research not yet fully explored. This study focuses on a 4 1/2-year prospective assessment of normative and subjective needs for care related to this specific area for a cohort living in the Dresden region (Germany). One significant result of this study shows the constant high level of needs for care in the area of suicidal behavior imposed on community services by 30-40% of this diagnostic group. Furthermore, the study identified a special high-risk subgroup for suicides as well as specific needs for care. This subgroup is characterized by clinical reasons for the index hospitalization (suicidal risk or attempt) as well as by psychopathological features (suicidal thoughts and higher levels of anxiety/depression) 1 month after release from index hospitalization. Four items of care were rated as potentially effective for addressing suicidality in the community setting: clinical assessment, increased supervision or systematic recording of (suicidal) behavior, medication, and a sheltered environment. Because these care measures are provided, the percentage of unmet normative needs for the area of suicidal behavior was rather low. Due to limitations of the instrument used for assessment of normative needs, the Needs for Care Assessment (NFCAS), the care measures most frequently provided do not define a quality standard of community care for this problem. A subjective needs assessment differing from the normative approach has to be integrated in establishing guidelines for effective community care.
Background The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. Method At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. Results 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Conclusions Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.
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