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Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice: the VELO study.

Bjorbekkmo S, Myklebust LH, Olstad R, Molvik S, Nymann A, Sørgaard K - Int J Ment Health Syst (2009)

Bottom Line: In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units.We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units.The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nordland Hospital Trust Vesteraalen, DPS, Stokmarknes, Norway. svein.bjorbekkmo@nordlandssykehuset.no

ABSTRACT

Background: The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.

Methods: 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.

Results: We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.

Conclusion: The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

No MeSH data available.


Related in: MedlinePlus

Possible factors influencing outcome in mental health services.
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Related In: Results  -  Collection

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Figure 1: Possible factors influencing outcome in mental health services.

Mentions: What determines treatment practice in the mental health field? [3]. Is it mainly socio-political trends, the structure or history of organizations, geography, the patient population or the staff's age, professional background and experience? Treatment programs are to a large extent adjusted to different clinical types of patients. This is supposed to be a central determinant. But our data indicates that differences in staff competence and education, and organizational characteristics may influence treatment philosophy and consequently practice. On the basis of our results, we have created a hypothesis of the relationship of these variables (figure 1). If results from the present study can be generalized, there seems to be a tendency that hospitals give what could be called a more medically oriented treatment over longer time with emphasis on evaluation and coping with aggression and less emphasis on cooperation with municipal health and social services. Lack of tradition and geographical closeness to patient's network may give newer organizations like CMHC with more flexible organizational frames and younger staff with educations and training that implies other treatment philosophies an advantage over presumably more slow-to-change large hospital organizations. When it comes to treatment of severely ill patients this hypothesis must be tested further.


Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice: the VELO study.

Bjorbekkmo S, Myklebust LH, Olstad R, Molvik S, Nymann A, Sørgaard K - Int J Ment Health Syst (2009)

Possible factors influencing outcome in mental health services.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2691730&req=5

Figure 1: Possible factors influencing outcome in mental health services.
Mentions: What determines treatment practice in the mental health field? [3]. Is it mainly socio-political trends, the structure or history of organizations, geography, the patient population or the staff's age, professional background and experience? Treatment programs are to a large extent adjusted to different clinical types of patients. This is supposed to be a central determinant. But our data indicates that differences in staff competence and education, and organizational characteristics may influence treatment philosophy and consequently practice. On the basis of our results, we have created a hypothesis of the relationship of these variables (figure 1). If results from the present study can be generalized, there seems to be a tendency that hospitals give what could be called a more medically oriented treatment over longer time with emphasis on evaluation and coping with aggression and less emphasis on cooperation with municipal health and social services. Lack of tradition and geographical closeness to patient's network may give newer organizations like CMHC with more flexible organizational frames and younger staff with educations and training that implies other treatment philosophies an advantage over presumably more slow-to-change large hospital organizations. When it comes to treatment of severely ill patients this hypothesis must be tested further.

Bottom Line: In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units.We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units.The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nordland Hospital Trust Vesteraalen, DPS, Stokmarknes, Norway. svein.bjorbekkmo@nordlandssykehuset.no

ABSTRACT

Background: The VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.

Methods: 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.

Results: We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.

Conclusion: The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

No MeSH data available.


Related in: MedlinePlus