Thirty years of referrals to a community mental health service

ObjectivesIn recent decades mental health services have become increasingly community based and multidisciplinary. However, it is unclear if referrals have changed over this period. The aim of this study was to compare referrals to a community mental health service over a 30-year period.MethodNew referrals to a community mental health service were randomly sampled from 4 time points over a 30-year period, 1983, 1993, 2003 and 2013, using a mental health information system. Original referral letters were retrieved and anonymised. Referrals were compared with regard to referral sources, demographics, reason for referral, psychotherapy requests, urgency, risk concerns and subsequent hospital admission.ResultsThere was a 20-fold increase in the number of new referrals between 1983 and 2013. Over the 30 years there was a significant decrease in the proportion of referrals expressing concern about psychosis, but an increase in the proportion that were deemed urgent and which were concerned with suicidal risk. Referrals in 2013 were longer and more likely to contain requests for psychotherapy.ConclusionsThe work of community mental health teams is increasingly concerned with emotional crises. Although services are now more multidisciplinary, they have not been adequately resourced to meet these changing demands.

Validasi Klinik Strenghts and Difficulties Questionnaire (SDQ) sebagai Instrumen Skrining Gangguan Tingkah Laku

Conduct Disorder is one of the most common problems often found in children taken to Puskesmas. Based on SIKM (Mental Health Information System) from 2011 to May 2013, 46.3% of those taken to Puskesmas in Sleman and Yogyakarta were identified with behavioral and emotional disorder. Therefore, screening instrument is needed for early identifying conduct disorder in them. Strengths and Difficulties Questionnaire (SDQ) has been developed to meet the need. The SDQ is a 25-item questionnare about the positive and negative atributes of children and adolescents (4-16 years old). This study aimed to adapt the English version of SDQ-Teacher Reports (TR) into Indonesian version and to examine psychometrical properties and clinical validation of the Indonesian version for screening conduct disorder. The subjects were 161 Elementary students from Sleman and Yogyakarta, boys and girls of 7-13 years old of age. The reliability coeficient using Alpha Cronbach was α=0,773, and the construct validity using Principal Axis Factoring (PAF) showed that SDQ-TR had six structural factors. Clinical validation using Receiver Operating Curve (ROC) revealed that the value of sensitivity were 0.67 with spesificity 0.68 (for the optimum cut-off point ≥5), and using Likelihood Ratio (LR) showed LR (+) was 2.09 and LR (-) was 0.49. Keywords: children, clinical validation, conduct disorder, SDQ-TR

Disparities in mental health care provision to immigrants with severe mental illness in Italy

Aim.To determine whether disparities exist in mental health care provision to immigrants and Italian citizens with severe mental illness in Bologna, Italy.Methods.Records of prevalent cases on 31/12/2010 with severe mental illness and ≥1 contact with Community Mental Health Centers in 2011 were extracted from the mental health information system. Logistic and Poisson regressions were carried out to estimate the probability of receiving rehabilitation, residential or inpatient care, the intensity of outpatient treatments and the duration of hospitalisations and residential care for immigrant patients compared to Italians, adjusting for demographic and clinical covariates.Results.The study population included 8602 Italian and 388 immigrant patients. Immigrants were significantly younger, more likely to be married and living with people other than their original family and had a shorter duration of contact with mental health services. The percentages of patients receiving psychosocial rehabilitation, admitted to hospital wards or to residential facilities were similar between Italians and immigrants. The number of interventions was higher for Italians. Admissions to acute wards or residential facilities were significantly longer for Italians. Moreover, immigrants received significantly more group rehabilitation interventions, while more social support individual interventions were provided to Italians.Conclusions.The probability of receiving any mental health intervention is similar between immigrants and Italians, but the number of interventions and the duration of admissions are lower for immigrants. Data from mental health information system should be integrated with qualitative data on unmet needs from the immigrants' perspective to inform mental health care programmes and policies.