Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns ...of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level.
Major efforts worldwide have been made to provide balanced Mental Health (MH) care. Any integrated MH ecosystem includes hospital and community-based care, highlighting the role of outpatient care in ...reducing relapses and readmissions. This study aimed (i) to identify potential expert-based causal relationships between inpatient and outpatient care variables, (ii) to assess them by using statistical procedures, and finally (iii) to assess the potential impact of a specific policy enhancing the MH care balance on real ecosystem performance. Causal relationships (Bayesian network) between inpatient and outpatient care variables were defined by expert knowledge and confirmed by using multivariate linear regression (generalized least squares). Based on the Bayesian network and regression results, a decision support system that combines data envelopment analysis, Monte Carlo simulation and fuzzy inference was used to assess the potential impact of the designed policy. As expected, there were strong statistical relationships between outpatient and inpatient care variables, which preliminarily confirmed their potential and a priori causal nature. The global impact of the proposed policy on the ecosystem was positive in terms of efficiency assessment, stability and entropy. To the best of our knowledge, this is the first study that formalized expert-based causal relationships between inpatient and outpatient care variables. These relationships, structured by a Bayesian network, can be used for designing evidence-informed policies trying to balance MH care provision. By integrating causal models and statistical analysis, decision support systems are useful tools to support evidence-informed planning and decision making, as they allow us to predict the potential impact of specific policies on the ecosystem prior to its real application, reducing the risk and considering the population's needs and scientific findings.
The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted ...a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.
Objectives
This study aimed to identify which are the socio-demographic factors that can describe health information users’ profiles in Europe and assess which are the factors distinguishing users ...and non-users and their association with the use of health-related online information.
Methods
Data from the Flash Eurobarometer No. 404 (2014) was analysed through a multilevel logistic regression model and a propensity score matching.
Results
There were significant differences in the use of the Internet for health information according to gender, age, education, long-term illness and health-related knowledge. Thus, some digital divides persisted in the use of health information online. Results showed that a poor health status was associated with a higher use of the Internet for health purposes only for people having chronic conditions.
Conclusions
Findings show a need to increase people’s eHealth literacy, especially for males over 45 years old not suffering from a long-term illness. In order to limit the misuse of poor or untrustworthy health information that might contribute to higher health disparities, special interest should be focused on population socio-demographic characteristics.
Anxiety disorders are the most prevalent psychological disorders during emerging adulthood. Some consistent gender differences have been reported in anxiety with women suffering more anxiety than ...men, which has detrimental consequences in most life spheres in the youth and later life stages. The understanding of the development of anxiety in emerging adulthood requires a developmental perspective. The Developmental Assets Theory was postulated to describe the individual and the contextual resources which may foster positive youth development and mental health. The present study aims to analyze to what extent the gender differences in anxiety may be partly explained by gender differences in developmental assets. For this purpose, a cross-sectional study was conducted in which a sample of 1,044 youths (75.5% women; age range = 18-28; M age = 20.47, SD = 3.08) enrolled in 11 universities from different regions in Spain filled in self-report measures of developmental assets and anxiety symptoms. The participants completed an online survey with the scales, Developmental Assets Profile developed by the Search Institute (1) and Generalized Anxiety Disorder-7 (GAD-7) (2). The results showed more anxiety in the female subsample (at both the symptoms and clinical levels). Some gender differences in developmental assets were also observed. A partial mediation model, based on regression analyses, indicated that gender differences in anxiety were partly explained by gender differences in developmental assets. Thus, higher anxiety in the women was partly due to lower scores in positive identity and higher scores in positive values. These results suggested the need to design programs to prevent anxiety with specific measures for women youth to nurture positive identity and promote strengths and coping skills that allow them to get the benefits of well-being derived from positive values, thus, preventing worry and stress overload, which may lead to anxiety.
Abstract
In Andalusia, Community Social Service Centres (CSSCs) are funded by regulations following demographic, geographic, economic, and social disadvantage criteria. This study aims to analyse the ...geographical distribution of funding per inhabitant of CSSC by catchment area in Andalusia in 2019, and to study the statistical associations between funding and a range of demographic and socioeconomic indicators. The study spatial units (
n
= 184) included the catchment areas of CSSCs and, in the case of intramunicipal areas in large municipalities, they were grouped at the municipal level. Spatial autocorrelation measures were used to identify spatial clusters of high/low funding rates per inhabitant. Later, nonspatial and spatial regressions were applied to search for associations with different indicators (sex ratio, ageing index, dependency index, emigration rate, immigration rate, unemployment rate, population density, and employment rate in the primary sector). The geographical distribution of the funding of social services in Andalusia was not random since the analyses identified several spatial clusters with significantly high (hot spots) and low (cold spots) funding per inhabitant (
p
< 0.05). The funding rates were significantly (
p
< 0.05) and directly associated with the ageing index and the percentage of primary sector employees, and indirectly with the proportion of foreigners in the population and the population density. The hot spots were mainly located in rural and deprived areas, while the cold spots were in urban areas. The variables related to the regulated funding distribution criteria were not fully associated with higher financing. Instead, other additional variables showed significant associations (
p
< 0.05), such as primary-sector workers and foreign populations. The results showed that spatial analyses may support service assessment and decision-making in social policy.
Objective:
Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are ...available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity.
Method:
This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults.
Results:
The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales.
Conclusion:
The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.
Qatari health planning in the last decade aimed to make the transition from the traditional hospital-based psychiatric care to a community-based care, building an integrated and comprehensive mental ...health system. The objective of this study was to explore the mental health service provision in Qatar in 2018 and 2022. This time span coincided with two mental health plans (2013-2018 and 2019-2022) and one health plan (2018-2022).
This study followed a healthcare ecosystem approach, including context analysis and the standard description and classification of mental health services. Service provision was studied applying DESDE-LTC system (Description and Evaluation of Services and DirectoriEs-Long Term Care), an internationally validated methodology to assess and describe mental health services. Service data were analyzed along with sociodemographic indicators from public statistics to know the care context.
The availability of specialized mental health services increased for adults, although it remained the same for other age groups. The diversity of care and the weight of health-related care over social-related care also remained quite similar. It was noteworthy the development of new services for young adults, migrant workers, and female populations.
This was the first time that this service research methodology has been applied in a Middle East country to study its mental healthcare pattern. The analysis of the mental healthcare pattern in the study time period showed the continued progress toward community-based care in Qatar in the framework of three health plans and despite the unexpected COVID-19 world pandemic.
Abstract
Background
Geographic Information System (GIS) and Global Positioning System (GPS), vital tools for supporting public health research, provide a framework to collect, analyze and visualize ...the interaction between different levels of the health care system. The extent to which GIS and GPS applications have been used in dementia care and research is not yet investigated. This scoping review aims to elaborate on the role and types of GIS and GPS applications in dementia care and research.
Methods
A scoping review was conducted based on Arksey and O’Malley’s framework. All published articles in peer-reviewed journals were searched in PubMed, Scopus, and Web of Science, subject to involving at least one GIS/GPS approach focused on dementia. Eligible studies were reviewed, grouped, and synthesized to identify GIS and GPS applications. The PRISMA standard was used to report the study.
Results
Ninety-two studies met our inclusion criteria, and their data were extracted. Six types of GIS/GPS applications had been reported in dementia literature including mapping and surveillance (n = 59), data preparation (n = 26), dementia care provision (n = 18), basic research (n = 18), contextual and risk factor analysis (n = 4), and planning (n = 1). Thematic mapping and GPS were most frequently used techniques in the dementia field.
Conclusions
Even though the applications of GIS/GPS methodologies in dementia care and research are growing, there is limited research on GIS/GPS utilization in dementia care, risk factor analysis, and dementia policy planning. GIS and GPS are space-based systems, so they have a strong capacity for developing innovative research based on spatial analysis in the area of dementia. The existing research has been summarized in this review which could help researchers to know the GIS/GPS capabilities in dementia research.
Objectives:
This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme – a major reform to the ...financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users.
Methods:
We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions.
Results:
We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty.
Conclusion:
Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out.
Implications:
This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level.
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