Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice.

ABSTRACT: While diagnosis has traditionally been viewed as an essential concept in medicine, particularly when selecting treatments, we suggest that the use of diagnosis alone may be limited, particularly within mental health. The concept of clinical case formulation advocates for collaboratively working with patients to identify idiosyncratic aspects of their presentation and select interventions on this basis. Identifying individualized contributing factors, and how these could influence the person's presentation, in addition to attending to personal strengths, may allow the clinician a deeper understanding of a patient, result in a more personalized treatment approach, and potentially provide a better clinical outcome.

Mental Health & Disabilities Workforce Workgroup, December 12, 2012

The Iowa 2012 General Assembly charged the Iowa Department of Public Health with creating a mental health and disabilities group to make workforce recommendations in support of services to Iowans (Senate File 2315, Division II, Section 24). The Department of Human Services Mental Health Redesign Initiative was already underway since 2010. Workforce supply is a critical element of service capacity. IDPH leadership reviewed the legislative language, conferred with DHS leadership, appointed the workforce, and began deliberations in fall 2012.

Children's Mental Health and Well-Being Work-group Final Report, December 15, 2015

The children's mental health and well-being work group was formed in response to legislative direction to facilitate a study and make recommendations regarding children's mental health and the systems that assist children and families in Iowa.

Audit report on Southern Hills Regional Mental Health for the year ended June 30, 2015

Audit report on Southern Hills Regional Mental Health for the year ended June 30, 2015

Iowa Mental Health and Disability Services Commission, January 2016

This Annual Report of the Iowa Mental Health and Disability Services Commission (the Commission) is being submitted pursuant to Iowa Code § 225C.6(1)(h). The report is organized in two sections: (1) an overview of the activities of the Commission during 2015, and (2) recommendations formulated by the Commission for changes in Iowa law.

Annual Report: Division of Acute Disease Prevention, Emergency Response, and Environmental Health 2015 April 25, 2016

This report is a result of the ADPER & EH division management team retreat that was held on July 30 and 31, 2015 where a gap was identified in our communication with customers, especially when it came to sharing information about planning efforts. The purpose of this report is to provide a comprehensive look at what ADPER & EH has accomplished in the past year as well as what we are working on for the future. It also serves as an annual informational resource for stakeholders, local partners, policy makers and the general public.

Increasing prehospital emergency medical service interventions for nursing home residents.

QUESTION: In the ageing European population, the proportion of interventions by the emergency medical services (EMS) for elderly patients is increasing, but little is known about the recent trend of EMS interventions in nursing homes. The aim of this analysis was to describe the evolution of the incidence of requests for prehospital EMS interventions for nursing home residents aged 65 years and over between 2004 and 2013. METHODS: A prospective population-based register of routinely collected data for each EMS intervention in the Canton of Vaud. Linear time trends of incidence of requests to the EMS in nursing homes were calculated and stratified by age categories. RESULTS: The number of ambulance interventions in nursing homes for people aged 65 years and over (65+) increased by 68.9% (1124‒1898) between 2004 and 2013. A significant linear increase of the annual incidence of requests to EMS per 1,000 nursing home residents was found for people aged 65-79 (10.2, 95% confidence interval [CI] 6.2-14.2), 80-89 (16.5, 95% CI 14.0-19.0) and over 90 (12.1, 95% CI 5.8-18.4). EMS interventions in nursing home residents who required an emergency physician increased during the same period by 205.6% (from 106 to 324), representing an increase from 2% to 7% of all emergency physician interventions in the Canton. CONCLUSIONS: Our results confirmed an important increase in the incidence of EMS interventions in nursing homes during the last decade, far exceeding the actual increase of the nursing home population during the same period. This evolution represents an important opportunity to reconsider the EMS missions in the context of an ageing society.

Assessing positive mental health in people with chronic physical health problems: correlations with socio-demographic variables and physical health status

Background: A holistic perspective on health implies giving careful consideration to the relationship between physical and mental health. In this regard the present study sought to determine the level of Positive Mental Health (PMH) among people with chronic physical health problems, and to examine the relationship between the observed levels of PMH and both physical health status and socio-demographic variables. Methods: The study was based on the Multifactor Model of Positive Mental Health (Lluch, 1999), which comprises six factors: Personal Satisfaction (F1), Prosocial Attitude (F2), Self-control (F3), Autonomy (F4), Problem-solving and Self-actualization (F5), and Interpersonal Relationship Skills (F6). The sample comprised 259 adults with chronic physical health problems who were recruited through a primary care center in the province of Barcelona (Spain). Positive mental health was assessed by means of the Positive Mental Health Questionnaire (Lluch, 1999). Results: Levels of PMH differed, either on the global scale or on specific factors, in relation to the following variables: age: global PMH scores decreased with age (r=-0.129; p=0.038); b) gender: men scored higher on F1 (t=2.203; p=0.028) and F4 (t=3.182; p=0.002), while women scored higher on F2 (t -3.086; p=0.002) and F6 (t=-2.744; p=0.007); c) number of health conditions: the fewer the number of health problems the higher the PMH score on F5 (r=-0.146; p=0.019); d) daily medication: polymedication patients had lower PMH scores, both globally and on various factors; e) use of analgesics: occasional use of painkillers was associated with higher PMH scores on F1 (t=-2.811; p=0.006). There were no significant differences in global PMH scores according to the type of chronic health condition. The only significant difference in the analysis by factors was that patients with hypertension obtained lower PMH scores on the factor Autonomy (t=2.165; p=0.032). Conclusions: Most people with chronic physical health problems have medium or high levels of PMH. The variables that adversely affect PMH are old age, polypharmacy and frequent consumption of analgesics. The type of health problem does not influence the levels of PMH. Much more extensive studies with samples without chronic pathology are now required in order to be able to draw more robust conclusions.

Attachment, psychopathology, and religion: Introduction to this special section of Mental Health, Religion, & Culture

An international conference of psychology of religion, organised at the University of Lausanne (Switzerland) on 16 May 2012, took up the theme: "Attachment, psychopathology, and religion". Four speakers were invited: Pehr Granvist, Andrew Gumley, Isabelle Rieben, and Pascal Roman. Their reworked contributions are gathered in this special section of Mental Health, Religion, & Culture. The goal of this special section is to re-examine the whole of this subject of the bond between attachment and religion and/or spirituality in the cases of those persons suffering from mental health disorders.

Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study.

BACKGROUND: Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations. OBJECTIVE: In order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences. DESIGN: A total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays. RESULTS: More than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1-2 weeks). CONCLUSION: Clinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal.

Patients' Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care.

PURPOSE: Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients' needs are organized. This study investigates both general and specific dimensions of patients' needs for care. METHODS: Patients' needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients' perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients' personal motivations, needs, and wants. Four seventy-one patients' profiles were analyzed through exploratory factor analysis. RESULTS: A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) "finances" and "administrative tasks"; (b) "transports," "public places," "self-care," "housework," and "food"; and (c) "family," "children," "intimate relationships," and "friendship." CONCLUSION: As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

Mental Health of Expatriates in Finnish Enterprises in Brazil

Expatriation has become increasingly common due to the global trade expansion. Many large companies base their production facilities in far-flung countries, where experts are sent from their own countries to launch the operations. Working in a foreign environment demands from so-called expatriates considerable adaptability. This study aimed to investigate if following expatriation mental health difficulties were experienced by the employees themselves or their family members. This study investigated by a questionnaire and interviews how expatriate employees in Finnish companies operating in different regions of Brazil and their families adjusted. Investigated employees were required to be at least 6 months in expatriation. Data were collected in Brazil during their stay at least 3 months after the arrival. The survey covered 121 expatriate employees, that operated in 17 different companies, from which 71 employees from 10 different companies responded to the questionnaire. All the employees from the two largest enterprises and their spouses were invited to focus groups; in total 43 persons (22 employees and 21 employees’ spouses) participated in a group or individual interviews. No significant mental health difficulties were found among the expatriate employees. Only a tenth of the expatriate employees reported strain. The experience of strain symptoms was found to be related to long working days, intense working rhythm and lack of friends. Work satisfaction seemed to be an important mediator in the coping process. While abroad, the expatriate employees were highly recognized for their work. Due to the immature organization of work they could often use their creative capacities to improve the work flow. The opportunity to see the effects of their own contribution with their own eyes to the development of the enterprise made them feel good. The association between the expatriate employees’ adjustment and that of their spouses’ was evident. The spouses’ situation was markedly different than that of the expatriate employees’ themselves. Expatriation changed the family members’ previous division of tasks considerably. The expatriate spouses had to change their roles more than the expatriate employees themselves; since most of them were highly educated women, who were leaded through an identity crisis due to at least temporary renunciation of own work and career.