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Item does not contain fulltext, Methodisch werken lijkt makkelijk op papier, maar is moeilijk in de praktijk. De waan van de dag, waarin vaak vele zaken optreden die ook aandacht vragen, is dikwijls sterker. Juist daarom is methodisch samen werken met mensen met EPA nodig. Methodisch werken is hypothese toetsend werken. Dat betekent dat een behandel- of begeleidingsplan als een hypothese wordt gezien die steeds tussentijds getoetst moet worden. Dit vereist systematiek en structuur op twee niveaus. In de eerste plaats een structuur van de verschillende stappen in het methodisch werken, van doelformulering tot evaluatie. In de tweede plaats een systematiek in de gespreksvoering tussen cliënt en begeleider, die kan helpen om steeds terugkerende afleidingen het hoofd te bieden zonder daaraan voorbij te gaan. Dat is de essentie van methodisch werken: het samen stap voor stap, systematisch in begeleidingscycli, werken aan verandering. Zo blijft de zorg gefocust en blijven de betrokkenen alert.

Background: The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES. Methods: Observational data were obtained in three areas of the Netherlands from 2007 to 2016. In total, we included 71,707 contacts of patients aged 18 to 65 years. The outcome variable was voluntary or involuntary psychiatric admission. Suicide risk and personality disorder were assessed by PES-clinicians. Multivariable regression analysis was used to explore associations between suicide risk, personality disorder, and voluntary or involuntary admission. Results: Independently of the level of suicide risk, suicidal patients diagnosed with personality disorder were less likely to be admitted voluntarily than those without such a diagnosis (admission rate .37 versus .46 respectively). However, when the level of suicide risk was moderate or high, those with a personality disorder who were admitted involuntarily had the same probability of involuntary admission as those without such a disorder. Conclusions: While the probability of voluntary admission was lower in those diagnosed with a personality disorder, independent of the level of suicidality, the probability of involuntary admission was only lower in those whose risk of suicide was low. Future longitudinal studies should investigate the associations between (involuntary) admission and course of suicidality in personality disorder.

Item does not contain fulltext, BACKGROUND: Risk of suicide is notoriously difficult to assess, and no gold standard is available, in terms of an instrument of first choice. Many different instruments are in use, among which are some that are not properly psychometrically investigated. AIM: The aim of this study is to establish the psychometric properties of the Dutch version of the Nurses' Global Assessment of Suicide Risk scale (NGASR), and the feasibility of its use in assessing suicide risk. Therefore, our research questions are as follows: what is the reliability, validity, interpretability and feasibility of the NGASR? METHODS: A psychometric study of acceptability, reliability and predictive validity among 252 patients making use of a concurrent instrument, the Suicide Intention Scale (SIS), concurrent assessment by a physician and 6-month follow-up. RESULTS: Factor analysis identified five factors. Cronbach's alpha was .45. Intraclass correlation was .92 (95% confidence interval (CI) = .85-.95). Association between total NGASR and SIS was substantial and significant (B = 0.66, standard error of mean (SE) = 0.19, ss = .66, p = .003). NGASR total score had a significant and moderately strong association with judgement by a physician on 'suicidal thoughts' (odds ratio (OR) = 1.24, p = < .001) or 'suicidal thoughts or plans' (OR = 1.35, p = .001). No significant association of NGASR scores and 6-month follow-up of suicidality was found. CONCLUSIONS: Internal consistency of the NGASR and most of the subscales identified was low. Other indicators of reliability of the NGASR were sufficient, although predictive validity was poor. The NGASR did not outperform other instruments but is easy to use, and may contribute to identification of risk factors, as well as to a more integral assessment of suicide risk.

Contains fulltext : 154889.pdf (publisher's version ) (Open Access), BACKGROUND: This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. METHODS/DESIGN: Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. DISCUSSION: No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care. TRIAL REGISTRATION: Netherl

Title: Barriers and facilitators for implementing interventions for professionals providing long-term community mental healthcare to people with severe non-psychotic mental illness: a Grounded Theory approach. Background: A major challenge in mental healthcare is to bridge the gap between research and practice. Several studies have described that community mental healthcare for people with severe non-psychotic mental illness lacks a formal structure, and a solid basis that guides interventions. In order to successfully implement a new intervention, barriers and facilitators have to be explored. However, not much is known about the barriers and facilitators regarding the implementation of interventions within this field. Research question: What are the barriers and facilitators for the implementation of interventions for professionals providing long-term community mental healthcare to people with severe non-psychotic mental illness? Method: A qualitative study using a Grounded Theory approach was conducted. Data were gathered through a combination of fourteen individual interviews and one focus group. The focus groups and interviews were recorded using audio recording and transcribed verbatim. Data analysis was based on the Grounded Theory approach. Results: This study identified six categories of barriers and facilitators. Professionals perceived most barriers at the intervention level, and facilitators at the level of the organizational context. These findings correspond with the findings of other studies. Conclusion: This study provides new insights into barriers and facilitators as perceived by professionals. The surplus value was found to be the core category that drives the whole implementation. Barriers and facilitators cannot simply be seen as separate factors because they interact with each other within the process of implementation. Recommendations: It is recommended to use tailored implementation strategies that take the barriers and facilitators found wit

Background: This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. Methods/Design: Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. Discussion: No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care.

Background: The contact between patients with BPD and mental health nurses (MHN-s), on psychiatric admission wards, is at risk to evolve into ongoing ineffective interactions. To reduce this risk, insight in experiences and perceptions of BPD patients on admission wards should be used. Herein, previous studies provide a lack of insight. Aims and research questions: This study aims to provide insight in what interactions with MHN-s are perceived helping by patients with BPD on acute admissions wards. This insight can be used in practice and in training of MHN-s. The primary question is: ‘what interactions with MHN-s do patients with BPD perceive as helping to achieve their goal of hospitalization?’. Method: Semi-structured in-depth interviews were conducted with twelve participants after discharge from one of the six participating admission wards. A grounded theory approach was used to develop thematic descriptions of patients’ experiences and perceptions of helping responses. Results: Half of the patients perceived ‘coming to rest’ as the goal of hospitalization. Three themes emerged with regard to what interactions with MHN-s are perceived helping to achieve the goal of hospitalization: ‘help patients to ask for help’, ‘understand the patient as a person’ and ‘help patients to identify what they need’. Conclusion: This study provides insight in interactions with MHN-s that patient perceive as helping. This insight can help MHN-s to prevent negative effects of hospitalization and establish effective interactions with them. Recommendations: It is recommended to communicate open and clear about what patients can expect, to make use of the good contact that many patients have with a few of the MHN-s and to evaluate with patients the care that is given.

Background:Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme.Methods:Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively.Results:Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert.Conclusion:A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here. © 2014 Kool et al.; licensee BioMed Central Ltd.

Purpose: Some patients in psychiatric treatment are considered extremely difficult to treat because of the disruptive nature of their relationships with treatment staff. In this paper, we describe and evaluate a specialist inpatient treatment program for these patients. Design and Methods: Data were collected from medical records and daily reports of patients (n = 108). Pretest-posttest measurements were used to evaluate the treatment. Findings: The main treatment method consists of the provision of safety, structure, and cooperation. Treatment results show statistically significant changes from admittance to discharge. Practice Implications: The collaborative and consistent manner in which nurses approach the patients is crucial for quality of care. © 2013 Wiley Periodicals, Inc.