J.M. Caldas de Almeida

Burden on the families of patients with schizophrenia: results of the BIOMED I study

Abstract The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors, and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

S31-04 Depressive disorders in Portugal: EAAD and the depanx project regional baseline data and the WMH survey national data

Firstly, recent data on depressive disorders and suicidality burden in Portugal is presented and treatment gap is stressed as well as the insufficient information until recent years (1). At the national level, the first epidemiological study on psychiatric disorders embedded within the World Mental Initiative Survey is ongoing and prevalence and needs for care data will be presented. Implementation process of the EAAD 4-level intervention in Portugal is ongoing along with restructuring of both liaison and specialized mental health care on a regional sector of 350.000 inhabitants with a mental health specialised care department and four large primary care health centres, where liaison between 4 mental health teams and 200 GP was taking place accordingly with varying models (substitute care in most) and different clinical criteria for admission and follow-up. The restructuring of mental health teams and their missions implied that while a set of sub-teams stood responsible for severe mental disorders, another subgroup was deemed to comply exclusively with common mental disorders and primary care liaison aided by standardisation of clinical criteria for referrals evaluation and reply, specialised therapeutic interventions, as well as collaborative stepped care. Baseline and some outcome data on suicide and depression will be presented such as rates, psychopharmacological prescriptions, general population knowledge and beliefs, media reporting, and pre and post training evaluation of primary care professionals.

Unemployment as a source of mental distress to individuals and their family: Unemployed parents’ perceptions during the economic recession

Background: Due to the economic recession, several people in Europe became unemployed. This situation may risk their mental health. Aim: This study explored parents’ perceptions about their unemployment’s effects in daily life during the recession. Methods: A total of 59 unemployed parents (40.7% fathers and 59.3% mothers), ageing 44.4 years (±6.2), answer a question on how the unemployment affected their family lives. Thematic analysis was used to analyse data. Results: The findings suggest that unemployment is a source of adult and youth mental distress and of economic hardship and changes in family relations. Conclusion: Support to unemployed individuals and their families could benefit from these insights when granting the needed financial and socioemotional assistance.

Variation of Mental Health Case Management Fidelity in a Geographically Small Country

1. Introduction Strategies to implement evidence-based practices are critical to improve services. There are many barriers to their implementation, despite all available knowledge. Even geographically small countries like Portugal (92.152 km 2) can have substantial regional variations in evidence-based practices implementation. 2. Objectives Evaluate the regional variation of mental health case management fidelity during a systematic implementation process, according to the measurement of techniques and resources used by mental health professionals. 3. Methods The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a case management course, in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009). 4. Results Mental health professional’s assessment in 26 mental health public and private services (n=71) showed that there are significant differences in the proportion of case management adequate implementation between country regions (North = 35,7% / Centre = 57,5 / Lisbon and Tagus Valley = 65,3%, Alentejo 72,7% and Algarve = 50%). 5. Conclusion The results show that even in a geographically small country there are big differences in the quality and degree of effective practices implementation. This happens despite the fact that the implementation process was developed nationwide by the same training and implementation team, working with regional groups. Locally and regionally designed implementation programs are needed to balance the unevenness of evidence based practices fidelity and quality.

Barriers to Case Management Implementation: Differences Between Mental Health Teams in Portugal

1. Introduction Case management is defined as an evidence-based practice used to help patients in the recovery process. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice, but also from regional and local barriers to implementation. 2. Objectives To study the differences in the case management barriers to implementation, between Portuguese specialised mental health teams. 3. Methods Data was collected in 26 public and private mental health services of mainland Portugal. Barriers were assessed using the BaFAI - Barriers and Facilitators Assessment Instrument (Peters, 2001). Services profiles were made using a specific questionnaire. 4. Results Significant differences between mental health teams were found in the following barriers to implementation: 1. Resistance to use treatment protocols was higher in teams that routinely don’t use clinical guidelines (p=0,028). This barrier was also higher in services without research activity (p=0,034); 2. Barriers linked with space availability to implement the practice were higher in teams without liaison with the primary health care (p=0,045). 3. Barriers associated with professional’s difficulty to change were found in less specialised mental health teams (p=0,006). 5. Conclusion Special attention is needed to regional and local barriers to implementation in the process of mental health services quality improvement and innovation. Implementation protocols should include prior barriers assessment so that implementation plans can incorporate the strategies to tackle differences between mental health teams.

EPA-0721 – Measurement of fidelity in case management practice

Introduction Implementation research is crucial in the mental health field given that evidenced-based care still lack implementation, even in developed countries. In Portugal, the National Mental Health Plan included actions to change the operational model for mental health teams and a case-management (CM) training program was launched by the Ministry of Health. Objectives This study aims to evaluate the fidelity of a CM programme implementation process, according to the measurement of intervention techniques and resources used by mental health professionals. Methods The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a CM course (SAMHSA procedures), in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009). Results Mental health professionals assessment (n=71) showed a 15% good implementation rate and a 43% fair implementation rate, but still not enough implementation in 42%. Mean use of the model resources (e.g. duration and family involvement) was lower when compared with the use of techniques (e.g. goals definition, psychoeducation and relapse prevention). Conclusions Despite the fair global implementation rate of the CM model in the Portuguese mental health services, the rate of good implementation is still low. Implementation science may help to reduce the gap between evidence-based practices and their use in routine care, and thus contribute to improve the fidelity of evidence based care models for patients with severe mental illness.

EPA-0710 – Portuguese mental health services and workforce profiles

1. Introduction The scarcity of human resources is a factor that hampered the improvement of mental health (MH) services in Portugal. MH teams continue to rely on a small number of psychologists, nurses, social workers, occupational therapists and other non-medical professionals, with most teams maintaining traditional models care delivery. Nevertheless teams continue to evolve to ameliorate MH care considering present patients needs and effective treatments. 2. Objectives This study aims to describe services and workforce profiles in Portuguese MH services. 3. Methods The study was carried out at public and private MH services in mainland Portugal. Profiles were assessed by survey method related with two dimensions: 1 - services characteristics and 2 - workforce profile. 4. Results Assessment of services showed: liaison with primary health care (56%), routine use of guidelines (57%), use of individual care plans (46%), inservice research (25%). Regarding workforce, 19% of the teams still rely on 2 professional groups (Psychiatrist and Nurse), 88% do regular training, 60% reported use of case management models, but only 16% had formal training on the model. 5. Conclusion Despite the incremental inclusion of MH care essential components associated with services modernisation, Portuguese mental health teams still struggle to provide integrated care with the contribution of multiple professional groups in a multidisciplinary framework. This is specially true in the interior and rural areas of the country. Training programmes need to be maintained as a special priority by national and regional authorities to assure effective delivery of care.

2338 – Organizational culture and managers profiles in the portuguese mental health services

Introduction There is emerging evidence that organizational culture and leadership profiles influence the way health services implement their systems of care. Studies regarding organizational culture of services are widespread in economical and managerial areas but very few evaluate mental health care contexts. Most of these studies aim to help in the management of human resources. Objectives To assess the organizational culture and leadership profiles in the Portuguese mental health services. Methods Cross-sectional study, made in public and private mental health services. Evaluation was made by means of the competing values framework tool (Quinn, 1990) (Portuguese version - MJ Felicio, 2007), which includes dimensions such as organizational culture and leadership profiles in the framework of more open or close systems and with more control or flexibility strategies. Results There is no organizational or leadership profile clearly outstanding in the Portuguese mental health services. However Director and Coordinator leadership profiles scored higher in the results. These higher scores profiles were linked with assignment of duties, delegation of tasks and planning activities. Innovation profiles had the lowest scores, linked with the ability to cope with change and to manage change. Conclusions Further studies are critical to develop a clearer view regarding the influence of organizational culture and leadership profiles in the organization of mental health services. Low scores on innovation components may influence the way evidence based practices are welcomed and implemented in services.

2337 – Assessing the impact of a full-time clerkship in a portuguese medical school: a focus on attitudes and career choice

Introduction Due to the scarcity of mental health professionals, recruitment of psychiatrists is presently a major issue in Portugal. A negative attitude towards psychiatry or the psychiatrists role has frequently been observed in rather different countries - this is troublesome, given that medical graduates’ attitudes toward psychiatry has been pointed as a predictor of recruitment. On the other side, research suggests that a clerkship may improve the students attitudes, namely when they are stimulated to participate in the delivery of care. Objectives To assess the impact of a clerkship in the attitudes toward psychiatry among Portuguese medical graduates, as well as in the motivation to choose psychiatry for future training. Methods Balons self-reported questionnaires were administered to all 6th year students in a medical school in Lisbon, before and after a 4-weeks full-time psychiatric clerkship. Results 153 students were evaluated. After the clerkship, perceptions about the overall merits of psychiatry, efficacy, role definition, functioning of psychiatrists and use of legal powers to hospitalize patients were significantly improved. There was also a meaningful increase of trainees considering the possibility to take a residency in psychiatry. However, perceptions of low prestige and negative pressure from family and peers regarding a future choice of psychiatry remained unchanged in about one-third of the students. Conclusions Clerkship had an auspicious overall impact on the student attitude towards psychiatry,as well as in the number of students considering a future career in psychiatry. Attitudes toward psychiatry seems a promising outcome indicator of the clerkships quality.

P-681 - How different are the needs for care between forensic and civil psychiatric services users?

Introduction Mentally disordered prisoners (MDPs) have an increased vulnerability to victimization and suicide. In the last years, there is a trend to assign their treatment to the civil psychiatric services. Objectives To compare forensic with civil psychiatric services users (FPSUs vs CPSUs) regarding clinical and care needs. Methods A cross-sectional study of FPSUs and CPSUs from 2 prisons, 1 prison-hospital and 1 general hospital, all located in the Lisbon region, was conducted. The forensic sample was constituted by all users during one year period (2009–2010), and the civil sample was matched for age and gender. The data was collected from users and staff interviews. The instruments included a specific questionnaire, MINI, BPRS and CANFOR. Results The samples comprised 114 prisoners and 121 civil patients. FPSUs had better family inclusion and employment status but poorer academic achievement than CPSUs. The FPSUs presented significantly higher prevalence for major depression, suicide risk, anxiety disorders, drugs addiction and anti-social personality disorder than CPSUs. Comparatively, FPSUs had more prescriptions for hypnotics and CPSU had more prescriptions for antidepressants and anxiolytics. The FPSUs rated significantly more needs and unmet needs than CPSUs. However, the staff rated no differences between the two groups. Conclusions The FPSUs presented a higher prevalence of non-psychotic pathology than CPSUs. However, it seems that medication is insufficient regarding the clinical severity. The unmet needs of FPSUs were significantly higher than CPSUs, and cover multiple domains. The displacement of MDPs to civil psychiatric facilities should consider their specificities and needs.