Laura Grigoletti

Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health services

Providing care to individuals with complex mental health needs can be stressful. However, little research has focused on the emotional, cognitive, and physical consequences of providing mental health care. The aim of this study is to assess burnout (BO), compassion fatigue (CF) and compassion satisfaction (CS) among staff at the four community-based mental health services (CMHS) of Verona, Italy. All staff were asked to complete anonymously the Professional Quality of Life Scale, the General Health Questionnaire, and a socio-demographic questionnaire. In total 260 staff participated (a response rate of 84%). Psychiatrists and social workers were the professionals with the highest levels of BO and CF. Workers with psychological distress reported both higher BO and CF scores, and lower levels of CS. A significant increase in the BO and CF scores was also detected for each extra year spent working in a CMHS. A higher level of CF was associated with female and having been experienced one negative life event in the previous year. These findings are useful for health managers and team leaders to identify factors affecting the professional quality of life of mental healthcare staff, and can provide a rationale for detecting staff at risk for developing negative work-related outcomes.

Mortality and cause of death among psychiatric patients: a 20-year case-register study in an area with a community-based system of care

BACKGROUND Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services. METHOD All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population. RESULTS The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4). CONCLUSIONS This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.

DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience

PurposeThis study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy).MethodsData were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis.ResultsThe only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient’s local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation).ConclusionsFor the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.

Which factors affect the costs of psychiatric residential care? Findings from the Italian PROGRES study

Objective:  In the latest years, mental hospitals have gradually been replaced by a community‐based network of facilities, including non‐hospital residential facilities (RFs). Little information is still available about their costs. Our aims were to estimate the costs of Italian RFs and to evaluate which factors affect the cost of RFs and their patients.

Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia

BackgroundIn Georgia, difficult socioeconomic conditions have resulted in a drastic decrease in government financing for the health sector. State mental hospitals continue to be the main solution for the mentally ill, due to the severe lack of community-based services, and mental health services are inadequate to meet the needs of patients.MethodsAn experimental intervention of assertive community care was implemented with the aim to engage socially isolated patients who lacked contact with outpatient services and to answer their different social and psychological needs. The intervention lasted 10 months and consisted of outpatient visits, visits at home, meetings outside and telephone calls to the services’ facilities; all services were provided by a multidisciplinary team. The intervention was conducted in a psychiatric dispensary in the district of Tbilisi, Georgia.ResultsThis pilot study showed the economic sustainability of community care and its effectiveness to facilitate continuity of care and to improve clinical and social outcomes.ConclusionsHigh-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care.

A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

AIM To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifying the costs of these packages. METHODS Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. RESULTS Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. CONCLUSION It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

[Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost)].

AIMS To obtain a new, well-balanced mental health funding system, through the creation of (i) a list of psychiatric interventions provided by Italian Community-based Psychiatric Services (CPS), and associated costs; (ii) a new prospective funding system for patients with a high use of resources, based on packages of care. METHODS Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographical and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were registered and categorised into 24 service contact types. Using elasticity equation and contact characteristics, we estimate the costs of care. Cluster analysis techniques identified packages of care. Logistic regression defined predictive variables of high use patients. Multinomial Logistic Model assigned each patient to a package of care. RESULTS The samples socio-demographic characteristics are similar, but variations exist between the different CPS. Patients were then divided into two groups, and the group with the highest use of resources was divided into three smaller groups, based on number and type of services provided. CONCLUSIONS Our findings show how is possible to develop a cost predictive model to assign patients with a high use of resources to a group that can provide the right level of care. For these patients it might be possible to apply a prospective per-capita funding system based on packages of care.

Mental health care financing in Italy: current situation and perspectives.

Abstract Through a review of the studies conducted on the analysis of the costs of the Italian mental health provision of care, this study aimed at describing the current financing system for mental health care in Italy. From the deinstitutionalization to the present days, Italian mental health care financing has evolved in line with both national plans and the actual European directives. The description of the current situation of mental health care financing in Italy can be useful to inform service planning and resource allocation, and to offer a wider European perspective.

The cost and utilization of psychotherapy in Community-bases Mental Health Services. A multicentre study in five Italian areas

AIMS To investigate the prevalence of psychotherapy intervention in five Italian Centres for Mental Health. Analysing sociodemographic characteristics, geographical differences, frequencies of psychotherapy interventions, and the costs of these interventions. METHODS Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographic and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were recorded and categorised into 24 service contact categories. A comparison between patients who received or did not receive psychotherapy was made. RESULTS The socio-demographic characteristics of patients are very similar to those found in previous studies; there is a great difference in the number of psychotherapy treatments between the five areas. Psychotherapy patients use different services compared to the other patients, and their care cost less. CONCLUSIONS This study provides a description of the provision of psychotherapy by Italian Mental Health Services. Further research is required into this topic.

Erratum to “Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health service” [Psychiatry Research 200 (2–3) (2012) 933–938]

Erratum to ‘‘Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health service’’ [Psychiatry Research 200 (2–3) (2012) 933–938] Alberto Rossi , Gaia Cetrano , Riccardo Pertile , Laura Rabbi , Valeria Donisi , Laura Grigoletti , Cristina Curtolo , Michele Tansella , Graham Thornicroft , Francesco Amaddeo a a Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro10, 37134 Verona, Italy b Istituto di Medicina Legale e delle Assicurazioni, University of Macerata, Italy c Health Service and Population Research Department, King’s College London, Institute of Psychiatry, UK