Ulla Væggemose

Community families: A qualitative study of families who volunteer to support persons with severe mental illness

Background: Social interventions targeted at people with severe mental illness (SMI) often include volunteers. Volunteers’ perspectives are important for these interventions to work. This article investigates the experiences of volunteer families who befriend a person with SMI. Material: Qualitative interviews with members of volunteer families. Discussion: The families were motivated by helping a vulnerable person and by engaging in a rewarding relationship. However, the families often doubted their personal judgement and relied on mental health workers to act as safety net. Conclusion: The volunteer involvement is meaningful but also challenging. The families value professional support.

Community Families: Bridging the gap between mental health services and civil society – A qualitative study from users’ perspective:

Background: Social interventions to support people with severe mental illness are important to improving the quality of life. The perspectives of users are essential in this process. This article explores users’ experiences, investments and concerns of a befriending programme. Material: Focus group and individual qualitative interviews with service users. Discussion: Overall, the experiences with the programme were positive, and the social interaction was highly valued. However, that the relationships were arranged and facilitated by mental health workers remained an unresolved concern even after several years. Conclusion: People with severe mental illness benefit from relationships despite the need of professional assistant.

Cost Analysis of Community Based Family Support of Patients with Severe Mental Illness

Community-based family support is a new option to patients with severe mental illness in which the patient and a volunteer family meet on a regular basic. This study examined whether this support could reduce patients’ use of psychiatric services. This matched case-control study included 86 patients with severe mental illness. 40 patients were offered the intervention: community-based family support intervention. Patients’ use of psychiatric hospital services was followed from 2 years before to 2 years after the intervention using a difference-in-difference analytical approach. Although community-based family support seemed to reduce hospital admission, the reduction in cost did not compensate the cost of the programme. However, this does not rule out the potential cost effectiveness, and future studies should assess the clinical benefits and cost effectiveness of community-based family support. The present study does not provide sufficient basis for recommending the general implementation of community-based family support.

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics

Objectives Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. Design, participants and setting 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. Intervention A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. Main outcome measures The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. Results All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI –9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. Conclusions At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. Trial registration number ISRCTN61925912.