scholarly journals The future of community-centred health services in Australia: lessons from the mental health sector

2010 ◽  
Vol 34 (1) ◽  
pp. 106 ◽  
Author(s):  
Alan Rosen ◽  
Roger Gurr ◽  
Paul Fanning
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Health Care Services ◽  
Cost Effective ◽  
Community Health Services ◽  
International Studies ◽  
Care Services

•It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. •Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. •The reasons for these trends are explored. •The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. •Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such community-centred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What is known about the topic?Community-centred health care has been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions, e.g. in mental health service systems. A growing international expert consensus suggests that such community-centred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What does this paper add?Despite this global consensus, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends and possible solutions are explored. What are the implications for practitioners?Unless this trend is reversed, the loss of convenient public access to community health services at shopping and transport hubs and the consequent compromising of intensive home-based clinical care, will lead to a deterioration of preventative interventions and the health care of long-term conditions, contrary to international studies and reviews.

scholarly journals How to Screen Suitable Service Improve Community Health Care Services by University Students in Taiwan

2020 ◽  
Vol 17 (15) ◽  
pp. 5402 ◽  
Author(s):  
Guey-Shin Shyu ◽  
Shinn-Jou Lin ◽  
Wei-Ta Fang ◽  
Bai-You Cheng
Keyword(s):  
Health Care ◽  
Health Services ◽  
University Students ◽  
Community Health ◽  
Health Care Services ◽  
Explanatory Power ◽  
Community Health Services ◽  
Community Health Care ◽  
Care Services ◽  
Study Results

Engaging in social contributions to enhance social participation and attending community experiential service learning or internship courses have become an essential learning experience for university students. On the basis of postmodern education theories, this study adopted images and oral accounts involving personal experiences to construct a postmodern education research scheme by using the method of collaborative ethnography. This study selected and performed the following services: filming a community documentary, administering community health dance classes, and archiving community cultural artifacts in databases. Interviews were also administered to facilitate implementation of the actual services. Community health services commonly seen in Taiwan and abroad were compiled, and the resources required for each service were examined. Subsequently, factor analysis was performed to explore the characteristic of these services in order to recommend feasible services for university students to undertake. The results indicated that the eight resources required for the 59 common community health services were (1) a designated space or venue, (2) materials, (3) monetary resources, (4) human resources, (5) expertise, (6) professional equipment, (7) patience, and (8) empathy. The results revealed three principal components, namely labor services, high-resource services, and professional services, for a total explanatory power of 67.99%; the individual explanatory power of these components accounted for 25.04%, 21.81%, and 21.15%, respectively. Next, community health care services suitable for university students to perform were selected and implemented, and these services were well received. The study results indicated that community and environmental justice can be realized by identifying with the value of community health services and promoting postmodern education theories and social norms. The research results are suitable for implementation after the COVID-19 pandemic.

The COAG Reforms and Community Health Services

1995 ◽  
Vol 1 (1) ◽  
pp. 3 ◽  
Author(s):  
Stephen Duckett ◽  
Tracie Hogan ◽  
Jan Southgate
Keyword(s):  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Acute Care ◽  
Community Health Services ◽  
Community Wellbeing ◽  
Care Services ◽  
Acute Care Services ◽  
English Speaking ◽  
The Impact

Ultimately, the reform directions announced by the Council of Australian Governments (COAG) in April 1995 have the potential to touch all aspects of health care and community wellbeing, and the impact will be felt as much by community health services, and for groups with special needs, such as people from non-English speaking backgrounds, as it will for acute care services.

scholarly journals Impact of School-Based Health Centers on Students with Mental Health Problems

2008 ◽  
Vol 123 (6) ◽  
pp. 768-780 ◽  
Author(s):  
Jeff J. Guo ◽  
Terrance J. Wade ◽  
Kathryn N. Keller
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Care Services ◽  
Mental Health Problems ◽  
Health Problems ◽  
Care Services ◽  
School Based ◽  
School Based Health Centers

Objectives. School-based health centers (SBHCs) play an increasingly major role in providing mental health services for students. This study evaluated the impact of SBHCs on mental health-care services and psychosocial health-related quality of life (HRQOL). Methods. Four SBHC intervention and two matched non-SBHC school districts were examined from 1997 to 2003. The SBHC intervention began in 2000. Data included child and parent pediatric HRQOL and Ohio Medicaid claims. A longitudinal quasi-experimental time-series repeated measures design was used for this study, involving analysis of covariance to assess health costs and regression analyses for HRQOL scores. Results. After the SBHC program, proportions of students accessing mental health-care services for urban and rural SBHC intervention schools increased 5.6% (χ2=39.361, p<0.0001) and 5.9% (χ2=5.545, p<0.0001), respectively, compared with increases of 2.6% (χ2=2.670, p=0.1023) and 0.2% (χ2=0.006, p=0.9361) for urban and rural non-SBHC schools, respectively. Using data from 109 students with mental health problems based on Medicaid claims, the study found SBHC students had significantly lower total health-care costs (F=5.524, p=0.005) and lower costs of mental health services (F=4.820, p=0.010) compared with non-SBHC students. While improvements over time in HRQOL for SBHC students compared with non-SBHC students and students from non-SBHC schools were observed, only some were statistically significant. Conclusions. SBHC programs increase the proportion of students who receive mental health services and may improve pediatric HRQOL. SBHC students with mental health problems had lower total Medicaid reimbursements compared with non-SBHC students.

Mental Health in Sri Lanka: Challenges for Primary Health Care

2002 ◽  
Vol 8 (2) ◽  
pp. 31 ◽  
Author(s):  
Sudarshini Fernandopulle ◽  
Neil Thalagala ◽  
Simon Barraclough
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Sri Lanka ◽  
Mental Health Care ◽  
Health Care Services ◽  
Mental Health Problems ◽  
Community Health Services ◽  
Military Conflict ◽  
Care Services ◽  
Policy And Planning

Using a societal approach to the determinants of mental health, a survey of knowledge about mental health problems in Sri Lanka is presented, including the consequences of years of civil and military conflict and economic retardation. Sri Lanka has the highest suicide rate for females, and one of the highest rates for males, in the world. Mental health care services and their limitations are described. Major problems include under-funding of services and medicinal drugs, overcrowded institutions, shortages of trained personnel, and under-developed community health services. Desirable policy and planning reforms are identified; in particular the need for expanded primary mental health care.

scholarly journals Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

2020 ◽  
Vol 8 (5) ◽  
pp. 1-142 ◽  
Author(s):  
Anna Cantrell ◽  
Elizabeth Croot ◽  
Maxine Johnson ◽  
Ruth Wong ◽  
Duncan Chambers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Services ◽  
Intellectual Disabilities ◽  
Community Health ◽  
Health Care Services ◽  
Community Health Care ◽  
Care Services ◽  
Mapping Review ◽  
Adults With Intellectual Disabilities

Background In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy. Objectives To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research. Data sources MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018. Review methods The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis. Results The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters. Limitations The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes. Conclusions Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.

scholarly journals An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19 (Preprint)

2020 ◽  
Author(s):  
Luke Balcombe ◽  
Diego De Leo
Keyword(s):  
Mental Health ◽  
Machine Learning ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Service Delivery ◽  
Mental Health Care ◽  
Real Time ◽  
Health Care Services ◽  
Care Services

UNSTRUCTURED In-person traditional approaches to mental health care services are facing difficulties amidst the coronavirus disease (COVID-19) crisis. The recent implementation of social distancing has redirected attention to nontraditional mental health care delivery to overcome hindrances to essential services. Telehealth has been established for several decades but has only been able to play a small role in health service delivery. Mobile and teledigital health solutions for mental health are well poised to respond to the upsurge in COVID-19 cases. Screening and tracking with real-time automation and machine learning are useful for both assisting psychological first-aid resources and targeting interventions. However, rigorous evaluation of these new opportunities is needed in terms of quality of interventions, effectiveness, and confidentiality. Service delivery could be broadened to include trained, unlicensed professionals, who may help health care services in delivering evidence-based strategies. Digital mental health services emerged during the pandemic as complementary ways of assisting community members with stress and transitioning to new ways of living and working. As part of a hybrid model of care, technologies (mobile and online platforms) require consolidated and consistent guidelines as well as consensus, expert, and position statements on the screening and tracking (with real-time automation and machine learning) of mental health in general populations as well as considerations and initiatives for underserved and vulnerable subpopulations.

scholarly journals Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Manasi Kumar ◽  
Vincent Nyongesa ◽  
Martha Kagoya ◽  
Byamah B. Mutamba ◽  
Beatrice Amugune ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Care Providers ◽  
Health Care Services ◽  
Care Providers ◽  
Care Services ◽  
Primary Health

Abstract Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. Method and measures This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Results Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. Conclusion There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services.

Health Service Regionalization in New Brunswick, Canada: A Bold Move

1995 ◽  
Vol 25 (2) ◽  
pp. 271-282 ◽  
Author(s):  
Jack Reamy
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
New Brunswick ◽  
Health Care Services ◽  
Community Health Services ◽  
Hospital Services ◽  
Physician Services ◽  
Care Services

New Brunswick moved swiftly in 1992 to regionalize hospital and physician services along with the reform and expansion of other health care services. The dissolution of 51 hospital and community health services center boards and the establishment of eight region hospital corporations to oversee services in the seven health regions set the tone for regionalization in the province. The plan provides the flexibility to meet specific regional needs. The initial regionalization of hospital services was followed by the determination of the appropriate number, mix, and distribution of physician resources for each region, also to be managed by the region hospital corporation. The provincial government's central role not only guides the regions, but also uses incentives and disincentives to ensure that regional goals are met. While regionalization is not new and some components of the New Brunswick plan have been used elsewhere, the effort offers an integrated model for the regionalization of hospital and physician services, with the expansion of complementary services.

scholarly journals Pattern of Presentation and Utilization of Services for Mental and Neurological Disorders in Northeastern Nigeria: A Ten-Year Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jidda Mohammed Said ◽  
Abdulmalik Jibril ◽  
Rabbebe Isah ◽  
Omeiza Beida
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Low Income ◽  
Neurological Disorders ◽  
Health Care Services ◽  
Significant Proportion ◽  
Care Services

Mental and neurological disorders are common in the primary health care settings. The organization of mental health services focuses on a vertical approach. The northeast as other low income regions has weak mental health services with potentially huge mental health burden. The manner of presentations and utilization of these services by the population may assist in determining treatment gap. We investigated the pattern and geographical distribution of presentations with mental disorders and explored the linkages with primary care in northeastern Nigeria over the last decade. A retrospective review of hospital-based records of all the available mental health service units in the region was conducted over a decade spanning between January 2001 and December 2011. A total of 47, 664 patients attended available mental health facilities within the past decade in the northeast. Overwhelming majority (83%,n=39,800) attended the region’s tertiary mental health facility. A substantial proportion (30%,n=14,440) had primary physical illness, while 18%,n=8606, had primary neurologic disorders. The commonest physical comorbidity was hypertension (4%) and diabetes (2%). A significant proportion of the populace with mental disorders appeared not to be accessing mental health care services, even when it is available. Meaningful efforts to improve access to mental health services in the northeast region of Nigeria will require successful integration of mental health into primary and general medical services.

PTSD in Active Combat Soldiers: To Treat or Not to Treat

2014 ◽  
Vol 42 (2) ◽  
pp. 161-170 ◽  
Author(s):  
Bethany C. Wangelin ◽  
Peter W. Tuerk
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Health Care Services ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Public Health Care ◽  
Care Utilization ◽  
Care Services ◽  
Cost Effective Treatment

Treatment of military-related posttraumatic stress disorder (PTSD) is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) have sought VA health care services for PTSD. This recent increased need for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority.

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