Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study

2017 ◽  
Vol 26 (5) ◽  
pp. 491-499 ◽  
Author(s):  
Brian McKenna ◽  
Samantha McEvedy ◽  
Tessa Maguire ◽  
Jo Ryan ◽  
Trentham Furness
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Services ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mechanical Restraint

scholarly journals Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario

2017 ◽  
Vol 63 (6) ◽  
pp. 378-386 ◽  
Author(s):  
Alyson L. Mahar ◽  
Alice B. Aiken ◽  
Heidi Cramm ◽  
Marlo Whitehead ◽  
Patti Groome ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Services ◽  
Retrospective Cohort ◽  
Care Physician ◽  
Health Related

Objective: A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. Method: This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health–related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. Results: The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health–related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health–related reason (5.1% had at least 1 ED visit). Conclusion: Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.

Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

2021 ◽  
pp. bmjqs-2020-012975
Author(s):  
Peter J Kaboli ◽  
Matthew R Augustine ◽  
Bjarni Haraldsson ◽  
Nicholas M Mohr ◽  
M Bryant Howren ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Bed Occupancy ◽  
Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

scholarly journals Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0156652 ◽  
Author(s):  
Stephanie K. Y. Choi ◽  
Eleanor Boyle ◽  
John Cairney ◽  
Sandra Gardner ◽  
Evan J. Collins ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Mental Health Services ◽  
Health Services ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Treatment Network

scholarly journals Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

2020 ◽  
Vol 9 (11) ◽  
pp. 3774
Author(s):  
Domenico De Berardis ◽  
Antonio Ventriglio ◽  
Michele Fornaro ◽  
Federica Vellante ◽  
Giovanni Martinotti ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Services ◽  
Health Services ◽  
Everyday Clinical Practice ◽  
Mechanical Restraint ◽  
The Everyday ◽  
Mechanical Restraints

Restraining interventions, which comprise physical (PR) and mechanical restraint (MR), have a long history in mental health services [...]

scholarly journals Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037853
Author(s):  
David Boulos ◽  
Bryan Garber
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Health Concern ◽  
Military Population

ObjectiveTo determine whether post-deployment screening is associated with a shorter delay to diagnosis and care among individuals identified with a deployment-related mental disorder.DesignRetrospective cohort study.SettingCanadian military population.ParticipantsThe cohort consisted of personnel (n=28 460) with a deployment within the 2009 to 2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. We restricted our analysis to individuals who had an opportunity to undergo screening and were subsequently diagnosed with a mental disorder that a clinician indicated was deployment-related (n=1157).InterventionsPost-deployment health screening.Main outcome measureThe outcome was delay to diagnosis and care, the latency from individuals’ deployment return to their mental disorder diagnosis date. Cox proportional hazards regression assessed screening’s influence on this outcome.Results74.4% of the study population had screened. Overall, the median delay to care was 766 days, 578 days among screeners and 928 days among non-screeners—a 350-day difference. Cox regression indicated that screeners had a significantly shorter delay to care (adjusted HR (aHR), 1.43 (95% CI, 1.11 to 1.86)). Screening findings had a substantial influence on delay to care. Identification of a mental health concern, whether a ‘major’ concern (aHR, 3.36 (95% CI, 2.38 to 4.73)) or a ‘minor’ concern (aHR, 1.46 (95% CI, 1.08 to 1.99)), and a recommendation for mental health services follow-up (aHR, 2.35 (95% CI, 1.73 to 3.21)) were strongly associated with shorter delays to care relative to non-screeners.ConclusionsReduced delays to care are anticipated to lead to beneficial outcomes for both the individual and military organisation. We found that screening was associated with a shortened delay to care for mental disorders that were deployment-related. Future work will further explore this screening’s components and optimisation strategies.

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