Good user pathways among persons with long-term mental health issues. Facilitators and barriers for Continuity of care

The primary objective of this project is to gain knowledge on good user pathways as a basis to improve services for mental health service users. By identifying factors that promote or hinder continuity of care, the project will provide a useful knowledge base for developing more coherent and coordinated services. The data is based on a national survey of service use, unmet needs and perceived continuity of care among patients receiving outpatient mental health care in 2013 and a follow-up study among respondents who agreed to participate in new data collection a year later. Furthermore, data from registers and data on municipal mental health services has been used. The project has studied characteristics of the users' pathways and how the users perceive continuity of care, hereunder how the use of Individual Plan (IP) affects. The project presents findings indicating that having an IP is more beneficial for users with milder mental illnesses than for those with more severe mental disorders. Users with serious mental illnesses and an IP experienced more frequent changes in personnel as well as less autonomy and flexibility in the services. For users with milder mental health issues, on the other hand, having an IP seemed to be related to a number of benefits; easier access to services, better follow-up after discharge and an emergency system in place when needed. The results raise questions about the usefulness of IP as a tool for better coordination between services and user involvement when it comes to users with severe disorders. The Project has also investigated the association between Quality of life (QoL) and respectively smi and non-smi patients' perception of CoC, therapeutic relation and unmet need for services, controlling for socio-demographics and social relations. Again, data-analyses showed important differences between users with severe and non-severe illnesses. Patient-rated QoL was significantly associated with positive rating of CoC and therapeutic relationship in the non-smi-group, but not in the smi-group. An association between QoL and unmet needs for treatment was only found among non-smi-patients . Association between QoL and unmet need for activity/day-center, however, were found in both groups. Likewise, QoL associated strongly with good social relations and living together with spouse/partner. The study shows the importance of the social factor for good QoL; good social relations, living together with spouse/partner and access to activities and social network. This points to the importance of relatively simple actions of everyday life in terms of activity and social life that may give a good opportunity to improved QoL. Furthermore, of being aware of, and explore in more detail, how Coc and therapeutic relationship should be practiced in order to affect QoL among smi-patients as well. Moreover, the project analysed different types of admissions to specialist mental health care and estimated the prevalence of unplanned admissions. Our findings show that of 2358 patients 49 percent had emergency needs as reason for their admission, 34 percent were involuntarily admitted and 21 percent were readmitted (within 30 days after discharge). In total, 65 percent of patients had one or more of these admissions. However, some of the readmissions were not urgent, and we assume that these were planned. We estimate that at least 58 percent revolved around unplanned admissions. The results show the need for prevention of unplanned admissions through effective use of both municipal mental health and specialist services. Finally, we have examined the relationship between the number of municipal man years and patients treated in the mental health. Patient data from the national patient register are linked to information on municipality of residence (from the National population register) for all patents using mental health specialist services, covering the period 2008-2016. The data was then aggregated on municipality, giving information on number of patients receiving specialist mental health services from each municipality each of the years. Information about resources used each year from each municipality is then included in the panel. The preliminary results from the analyses indicate that more patients receive specialist mental health services when primary health care increase their capacity.

As a consequence of de-institutionalisation, mental health care pathways have changed, with tasks now being taken care of by a range of primary and secondary health and care providers. This raises concerns about the fragmentation of care. The primary ob jective of this project is to gain knowledge on good user pathways as a basis to improve services to long-term mental health service users by identifying factors that either facilitates or hinder continuity of care. The work will be organized in three work packages (WPs). The main goal of WP1 is to identify what characterises mental health service users' pathways in the course of 12 or 18 months. In WP2 we will identify the users' perceptions of continuity of care related to their own pathway, and do a cross-cultural comparison between Norwegian and UK data. In WP3 we will identify structural mechanisms for continuity of care in the municipal mental health services. Data will be drawn from several sources. WP1 and WP2 will analyse data from a mapping of service use, unmet needs and continuity of care in the population of patients receiving treatment within the specialist mental health services (collected in an ongoing SINTEF-project). WP1 and WP2 will also do a follow-up survey 6 months later among da y- and outpatients. WP3 will utilize data from several sources, including cross-sectional surveys and registers. The knowledge generated by this project will facilitate good user pathways characterised by continuity of care, and increase the chances that users receive the right treatment in the right place at the right time.